Jennifer Jasper-Thompson was shocked when she received a call from the New Jersey department of corrections (DOC). Her nephew Damien Jasper, who had been incarcerated at Northern state prison in Newark, was dead at just 32.
His autopsy indicated that he had died from testicular cancer, considered one of the most treatable forms of cancer, even when caught in an advanced stage, with an overall five-year survival rate of 95%, according to the American Cancer Society.
Despite having a visible tumor and complaining for many months about severe pain, Jasper never received a cancer diagnosis or any treatment, according to records reviewed by the Guardian. Hence his family’s surprise, which soon turned not just to grief but outrage.
“The department of corrections killed my nephew,” Jasper-Thompson said.
Jasper’s potentially preventable death in 2020 is far from an isolated case. An exclusive investigation has revealed that people incarcerated in state prison in New Jersey are dying years younger than the overall population, often after receiving little healthcare when they get sick.
Records in that state are relatively accessible and help build a picture often obscured elsewhere. Advocates believe that alarmingly premature death in state prisons is a hidden crisis that is routine across the US, all too often fueled by abysmal and unconstitutional standards of healthcare.
From 2018 to 2022, men in New Jersey prisons died at an average age of 59 years and two months of age, and among those, Black men died at just under 57 years and four months of age. The incarcerated population is on average younger than the general population, yet these numbers are still startlingly low compared with the overall state average age of death recorded by the New Jersey health authorities of 71 years and eight months for all men and 64 years and four months for the state’s Black men.
In the state’s female prisons, only three women died during that period, at the relatively young average age of 51.3, compared with the society average of 78.6, although that data set is too small to draw conclusions.
Over the five years studied, the department of corrections held an average of 16,488 people in state custody, including 11,468 in adult male prisons and 515 people at Edna Mahan correctional facility, the sole institution designated for women.
David Fathi, an attorney and the director of the American Civil Liberties Union National Prison Project, reviewed the Guardian’s findings and said there are red flags that New Jersey has a “seriously dysfunctional prison healthcare system”.
However, the state is no exception, Fathi stressed. “What we know is that the provision of healthcare in prisons across the country is generally systemically inadequate,” he said.
In its 1976 ruling in Estelle v Gamble, the US supreme court found that “deliberate indifference” to the health needs of incarcerated people violated the eighth amendment’s protection against cruel and unusual punishment. Under the law, incarcerated people have a constitutional right to adequate healthcare that people outside prison do not – even if enforcing that protection has been a difficult task.
“I’d argue that the entire healthcare system in US prisons is deliberately indifferent,” said Wanda Bertram of the research and advocacy group Prison Policy Initiative.
By filing public records requests, the Guardian obtained data on all 272 individuals whom the DOC reported had died in New Jersey state prisons from 2018 to 2022, as well as autopsy results on 265 of those people. Heart disease accounted for 69 of the deaths, making it the leading cause, with people dying from the condition at age 62 on average. The next two most common causes of death were Covid-19 (average age of death: 60) and cancer (59).
By reviewing the autopsies as well as medical records, the Guardian concluded that some individuals, such as Jasper, died of treatable cancers, while others died of potentially treatable manifestations of chronic illnesses and potential complications of neglect.
The Guardian also calculated the average potential years of life lost for men in state prison compared with potential years of life lost for men in general society in New Jersey from 2018 to 2022.
Studying “potential years of life lost” is a common method used by government statisticians and academic researchers, and calculates the additional years a person was expected to live based on when they were born and their age at death. The method helps control for age-distribution differences between, for example, the prison population and the population at large.
The Guardian found that incarcerated men in state prisons lost about 6.5 more years of potential life on average compared to men in the state population overall. And they lost an average of 1.9 more years of potential life compared to male residents of New Jersey’s poorest cities, including Camden, Passaic, Newark, Paterson and Atlantic City. The numbers suggest that neither age distribution nor socioeconomic background and race completely explain why men in New Jersey prisons are dying so young, leaving the finger pointing at standards of healthcare in state prisons.
Kate LeMasters, a social epidemiologist and assistant professor at the University of Colorado Anschutz school of medicine, provided guidance in calculating potential years of life lost and interpreting the results.
“These findings are important, but, unfortunately, not surprising,” she said. “Individuals entering prison are sicker than the general population, often develop health issues during incarceration, and experience delayed and poor-quality care while incarcerated. This combination can create the perfect storm for early mortality.”
The investigation was conducted in partnership with the Gumshoe Group, an initiative supporting freelance investigative reporters pursuing public records-based investigations. Legal assistance in obtaining the records was provided by Gibbons law firm in New Jersey.
Previous academic research has found that prison can take a toll on life expectancy – as many as two years for every one year spent in prison. By analyzing autopsy and medical records, as well as interviewing friends and family, the Guardian can provide insight into how substandard medical care may contribute to early death, preceded by unnecessary suffering, and then heartbreak for loved ones left behind.
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Damien Jasper died a painful and potentially preventable premature death. The Guardian obtained his full medical records, with his family’s permission, and had them reviewed by Joseph Shin, assistant professor of medicine at New York’s Weill Cornell Medicine and an expert affiliated with the not-for-profit group Physicians for Human Rights.
Shin pointed out that according to the records, only once in Jasper’s time in department of corrections custody – in 2013 – did he complain about any health concerns regarding his genitals, which may explain why the visible tumor on Jasper’s body was never noted.
Still, doctors at the prison were aware something was wrong. In December 2018, Jasper began complaining of worsening lower back pain. In May 2020, weeks before he died, he was sent to the emergency room for an alleged aspirin overdose after gauging his level of pain as 10/10 and reporting it was “constant with little or no relief”, according to medical records.
While his medical providers did make efforts to address this pain, including conducting X-rays and referring him to physical therapy, there’s no indication they considered testicular cancer could be the cause. Shin opined after reviewing Jasper’s records that a whole chain of events, including missed leads, incomplete evaluations and diagnostic oversights, led to the failure to diagnose and treat his cancer. “We call this the Swiss cheese model of medical errors,” said Shin.
Describing a visit that took place just two days before he died, a physical therapist wrote that Jasper “reports of feeling a lot of pain in his lower back” despite being able to walk comfortably, leading them to conclude that the patient may be “a time waster”.
In reality, it’s highly likely that at least some of Jasper’s pain was cancer-related. During his autopsy, a giant mass measuring 4.7in by 3.5in was found in his periaortic lymph nodes, which are near the lower back.
Bias against incarcerated individuals may lead providers to overlook serious health issues and lead to a lack of trust between patient and provider, said Shin. “In this case, it contributed to a missed diagnosis, persistent and worsening pain, and perhaps a preventable death,” he said.
Francis Hannon, 78, who is currently incarcerated at New Jersey state prison, said that Jasper approached him in April 2019, concerned about a lump in his scrotal area as well as pain radiating to his lower back. Jasper asked Hannon to research possible causes. Hannon, who provided undated notes from this conversation to the Guardian, said he suspected Jasper was more open with prison healthcare providers than is reflected in the records.
“He went to these people for the necessary health help and assistance and he didn’t get it,” Hannon said.
Jasper-Thompson recalled her nephew as a wonderful artist “who could draw anything” and was kind and loving to family and friends but who, in prison, had been treated as though he were nobody, “as though his life didn’t matter”. She said she wanted to speak out in hopes of helping others.
“It has to stop,” she said. “We’re not all just bad people. We’re not! They need to treat these prisoners with more respect and dignity than they do.”
She added: “I fought for Damien from the day he was born. They need to pay for what they did to my nephew.”
The family sued over Jasper’s death, but the lawsuit was dismissed on procedural grounds.
The New Jersey department of corrections told the Guardian they were unable to comment on any individual cases. In an overall statement provided, the department stressed that “social determinants of health significantly impact individuals’ wellbeing before they enter NJDOC custody” and that “justice-involved individuals are disproportionately more likely to have chronic health conditions”.
The NJDOC further stated: “The safety and security of the individuals within the custody of the New Jersey Department of Corrections is a priority, including the physical and mental health of the incarcerated population.”
The medical records of another man who died in NJDOC custody, Elijah Sumler, suggest that people with chronic conditions may also receive inadequate care. Since 2013, when Sumler underwent brain surgery to remove a tumor, Sumler had relied on steroids to stay alive, due to a serious but manageable condition known as hypopituitarism.
In the weeks leading up to Sumler’s death in January 2022 at the age of 40, he had tested positive for Covid-19, according to his death records. People dependent on steroids often need to increase their doses when battling infections and should be under close supervision – including having their electrolyte levels, blood pressure and other vital signs regularly checked – to ensure they aren’t experiencing complications of a hormone insufficiency.
There’s no indication in Sumler’s medical record that providers were aware he could suffer Covid-related complications, or that they were monitoring him with that in mind.
If that was not considered, it could constitute a serious lapse in medical judgment, said Shin. If the providers thought about this and still failed to monitor Sumler, it could constitute negligence, he added.
“We’re left here with someone who’s died and a lot of unanswered questions,” said Shin.
The symptoms Sumler experienced immediately before his death – including lethargy, vomiting and low blood sugar, according to his records – may suggest he was experiencing acute adrenal insufficiency, according to Shin. But without vital signs or lab values, Shin acknowledged that it was impossible to know for sure.
Sumler’s official cause of death is listed as “complications of panhypopituitarism”, with Covid noted as a contributing factor.
At the time of his death, Sumler had spent about 10 years in department of corrections custody and was due to be released. His son, Elijah Jr, was six months old when Sumler was arrested, said Dysheeka Atkins, Elijah Jr’s mother. Atkins and Elijah Jr regularly visited Sumler in prison, she added.
“We were looking forward to him coming home,” said Atkins. “I’m fighting for them to acknowledge Elijah, acknowledge that he was a human being, that he was tremendously loved, and that his life meant something.”
Sumler’s family filed a lawsuit against leadership at the New Jersey department of corrections and Rutgers University Correctional Health Care in August 2023. The defendants have denied the allegations and asked for the case to be dismissed on procedural and substantive grounds.
According to the US Department of Justice, in 2019 the No 1 cause of death in US jails, where people await trial or serve relatively short sentences, was suicide. But prisons, where people are sent after being convicted of serious crimes, are different.
For example, according to the justice department, in 2019, 78.9% of state prisoners died due to illness, such as heart disease or cancer.
In the Guardian’s investigation, of the 265 autopsies reviewed, about 85% of incarcerated people were found to have died of natural causes, after spending an average of 14.2 years behind bars. Thirteen people died of accidental overdoses and four by suicide.
Meanwhile, according to data gathered under the Death in Custody Reporting Act, in 2019 New Jersey reported 235 deaths per 100,000 prisoners, compared to 678 in Louisiana, 588 in Alabama, 544 in Mississippi and 113 in Minnesota, for example. Nationally, the release of statistics is patchy, and the act has been widely criticized by researchers, as well as elected officials, as ineffective. A 2022 bipartisan Senate investigation found that the Department of Justice, charged with implementing the act, had been leaving hundreds of carceral deaths uncounted, in what the senator Jon Ossoff, a Democrat of Georgia, called at the time a “moral disgrace”.
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David Battinelli is the executive vice-president and physician-in-chief at Northwell Health, New York state’s largest healthcare provider. He’s also a dean and professor of medicine of the Zucker School of Medicine at Hofstra/Northwell. Battinelli’s brother, Thomas, died in NJDOC custody in October 2019 at age 62.
The Guardian was not given access to Thomas Battinelli’s medical records by the DOC, despite written permission from his mother, his next of kin.
Although Thomas Battinelli had pre-existing conditions when he was first transferred into NJDOC custody, in 2013, his health dramatically worsened as the years went on, said his brother. For years, in custody, Battinelli received dialysis for kidney disease through a catheter rather than an arteriovenous (AV) fistula, and this exposed his body to bacteria and resulted in frequent infections.
David Battinelli struggled to get through on the phone to the medical staff at South Woods state prison, he said. Instead, he sometimes opted to contact medical leadership within the NJDOC. When his brother was admitted to a local hospital, he made sure the chief medical officer was following the case. Despite these efforts, his brother didn’t receive the community standard of care. “There’s no question about that,” said Battinelli. “God knows what would have happened had I not been all over this from the very beginning.”
The Guardian also looked for patterns in the more than 250 autopsy and investigative reports it reviewed.
Almost 30 people had bedsores noted on their autopsies, including three who died, in part, of sepsis after developing bedsores and subsequent bone infections that spread to the rest of their bodies. One man was described as having a “vast, deep purulent” bedsore of the lower back and buttocks that measured 10in wide and 6in long.
Ageing individuals and those with mobility issues are vulnerable to developing bedsores – people who should not be in prison to begin with, say advocates. The state legislature passed a bill in 2020 making it easier for prisoners diagnosed with a terminal illness or a “permanent physical incapacity” to obtain compassionate release. But since then, only a handful of such individuals have been sent home, said Alexander Shalom of the ACLU of New Jersey.
In addition to Jasper, one other prisoner died of a cancer that’s rarely fatal: basal cell carcinoma. Of the four people who died of prostate cancer, two died before age 55. Between 2018 and 2021, only 1.2% of New Jersey residents who died of prostate cancer were that young, according to state health authorities.
Several people died from potentially preventable causes of blood loss, including ruptured esophageal varices and gastrointestinal ulcers, while others died from potentially preventable causes of sepsis, including a perforated bowel and an infected central line.
Examined in their entirety, the Guardian’s findings suggest that substandard healthcare is contributing to a pattern of early death behind bars.
Despite its apparent problems, some evidence suggests that New Jersey actually provides above-average medical care among state prison systems. In addition to the statistics about death rates in various states, in 2021, New Jersey’s South Woods state prison, where Thomas Battinelli died, was named a facility of the year by the National Commission on Correctional Health Care.
But Bonnie Kerness, who coordinates the national Prison Watch program at the Quaker advocacy group the American Friends Service Committee, said she had been getting complaints about medical care in the state’s prisons for decades.
In 2008, after a correctional healthcare division within Rutgers University was awarded a contract to operate the prison system’s medical care, which it still has, there was an expectation that care would get better, said Kerness, who is based in New Jersey.
However, she added: “It did not improve. I think just the opposite.”
That resonated with Hendrieka Fitzpatrick, a doctor who worked at the Edna Mahan correctional facility for women in Clinton, New Jersey, from December 2021 to December 2022. She also worked nights and weekends on call fielding urgent calls from nurses at men’s prisons in the state that required her to review medical records, put in orders and follow up as needed.
“The [prison] medical care system is substandard and biased,” said Fitzpatrick.
Fitzpatrick said that when she first started her job at Edna Mahan, she was told which prisoners should be considered liars or malingerers. She observed a medical staff member who required patients to sit silently until told to speak and who frequently conducted appointments without getting up from her desk or conducting a physical exam, sometimes while simultaneously attending a remote meeting, answering emails or reviewing lab results.
In a letter submitted to the American Friends Service Committee in April 2023, which was subsequently sent to NJDOC, Fitzpatrick outlined these concerns and said she had been verbally dissuaded by Edna’s medical leadership from pushing for better care. “When I expressed specific concerns about patient care and solutions, I was told I needed to become a ‘prison doctor’ with different standards of care,” she wrote in the letter, which was reviewed by the Guardian.
In its statement, the NJDOC explained that, under state law, it makes medical, mental health, vision and dental care available to the incarcerated population through Rutgers University Correctional Health Care (UCHC), the statutorily required healthcare provider, requiring it “to provide all appropriate and necessary medical services”. NJDOC said it “routinely audits and holds Rutgers … accountable for services provided and outcomes for the population”.
It added that: “The department continuously evaluates ways to improve and provide greater access to care … at all times, it is our intention that incarcerated persons receive care that is in line with accepted community standards.”
Rutgers UCHC did not respond to requests for comment.
Experts who spoke to the Guardian believe much more must be done to address understaffing and drastically improve standards, as well as records and communications systems.
They also suggested enhancing federal oversight of prison healthcare, and tasking the federal government with proactively tracking healthcare outcomes and holding state authorities accountable.
“Prisons are black boxes that are hidden from public view,” said Fathi of the ACLU. “It has to be someone’s job to make sure that adequate healthcare is being provided.”
That black box extends to loved ones. Some families did not know what their loved one had died of before hearing from the Guardian.
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New Jersey does have an office of corrections ombudsperson, whose powers were expanded under legislation passed into law in January 2020. Since being appointed in May 2022, ombdudsperson Terry Schuster has been “extremely responsive” to advocate concerns about conditions behind bars, said Bonnie Kerness, though it may be too soon to tell whether the office has the leverage to institute substantive change.
In recent years, the Democratic New Jersey governor, Phil Murphy, has been building a national profile as a prison reformer, including phasing out Edna Mahan, where incarcerated women have been subject to beatings and sexual abuse. In 2020, the state went from a high rate of Covid-related prisoner deaths, sparking protests, to a record number of early releases.
Tyler Jones, deputy press secretary to Murphy, sent this response to the Guardian’s request for comment: “Governor Murphy is committed to the safety and well-being of all incarcerated persons in our correctional facilities as they do the work to rehabilitate their lives, and the administration takes this type of reporting very seriously.”
Fathi said that changing the prison medical system in New Jersey and across the country may require changing the culture at large. Some Americans believe that once you’re in prison, “any bad thing that happens to you is a just desert – it’s part of your punishment”, he said.
For Shin, the American prison medical system has a fundamental problem.
“Carceral settings prioritize security and control,” he said, “so they function in ways that conflict with the basic tenets of medical ethics, including autonomy, beneficence [promoting wellness] and non-maleficence [obligation to do no harm]. It’s like fitting a round peg in a square hole.”
He said: “I wish there was a simple solution.” But, he fears:
“The problems just run too deep.”
