On a cold December day in 2021, the echoes of an emergency code cut through the bustling sounds of the Stafford Creek corrections center in Aberdeen, Washington.
The alarm could mean there had been a scuffle at the poker table, an officer was having a bad day, or a new lockdown due to yet another Covid outbreak was being imposed.
This time around, though, word spread across the facility that Clifford Farrar, an incarcerated resident, had collapsed in a common area.
Farrar, a 51-year-old with type 1 diabetes, had been insulin dependent since age 15. On the day he died, his medical records show, his blood sugar was dangerously low. When staff gave him glucagon to raise his levels, the records say, his blood sugar shot up, at which point he had a seizure and heart attack and died. The coroner said Farrar’s cause of death was “natural”, due to heart disease and diabetes.
But Farrar’s family believes the prison neglected his health throughout his detention, including by denying him access to life-saving supplies. A state committee found that staff responding to his collapse lacked proper training and that the medical devices they used had malfunctioned.
Farrar’s death, advocates argue, was a tragic but predictable consequence of the inadequate medical care within the Washington department of corrections (DOC), which has experienced repeated public health crises and scandals in recent years.
Even in a state considered one of the most progressive in the US, where the Democratic governor has pledged to make prisons “safer and more humane”, claims of systemic medical neglect have persisted, advocates point out, and in the last year, problems have escalated.
“They let him die. They killed my brother,” said Mary Farrar-McQueen, the sister of Farrar, who also leaves behind a wife and nine children. “My brother was not ‘sick’. He was only a diabetic like millions. He had a long life ahead of him. He died a senseless death, a preventable death.”
Deadly delays
Poor healthcare behind bars is a chronic problem across the US, where 2 million people are imprisoned; thousands die while locked up each year and incarceration has been shown to significantly reduce life expectancy.
“People in prison have a constitutional right to have serious medical needs taken care of,” said Hank Balson, an attorney who has advocated for prisoners’ healthcare in Washington. “But healthcare providers in the system often look at them as ‘offenders’ or ‘inmates’ and not as ‘patients’, and that can make it harder to recognize somebody’s pain as real or to feel compassion for their suffering.”
For years, families have complained that DOC has prioritized cost-cutting in prison healthcare, and investigations and lawsuits have exposed significant deficiencies. A prison medical director was fired in 2019 after an inquiry found that six incarcerated patients had suffered due to her inadequate care, including four who died, one due to an infected surgical wound and another who had a degenerative lung condition but did not see a specialist; the doctor has defended her care, saying the prison infirmary was a “problematic place to care for sick people”.
A recent state office of the corrections ombuds investigation uncovered significant and deadly delays in cancer diagnoses and treatments across DOC, which partially blamed the lack of electronic health records but also pledged to make its processes more efficient. In a 2020 report, Crosscut, a non-profit news organization, found that a third of people who die in DOC are younger than 55, many suffering from untreated or poorly treated illnesses, with the prison healthcare system frequently deciding that treatments for common and debilitating ailments are not “medically necessary”.
“It feels like if it’s not life-threatening in that moment or in the next 24 hours, then they put it off and tell you to drink water and take ibuprofen,” said Tonya Wilson, who was released from DOC in 2018 and is now an advocate with Freedom Project, a Washington-based group. “When people get out, they find that they have serious health problems that could have been addressed and mitigated while they were inside.”
It can be especially hard to get help when incarcerated people don’t have advocates on the outside pressuring officials, said LaKeisha Roselle, another formerly incarcerated Freedom Project advocate, who said she had struggled to get care for an infected cavity: “You’re not heard unless you have family out there fighting for you, and unfortunately I didn’t have that.”
The subpar standards were on display this year when one DOC prison erroneously injected 23 incarcerated people with a Covid antibody treatment instead of the vaccines they were told they were receiving. “It’s a debacle – how could this happen?” said Amy Crewdson, an attorney with Columbia Legal Services, a local non-profit that filed a complaint related to the incident.
At Stafford, where Farrar lived, five incarcerated people died of Covid, more than at any other prison in DOC, and the state twice fined the facility for “serious” and “willful” violations related to the coronavirus, finding staff repeatedly failed to follow basic safety protocols, even after the facility had been warned to make improvements. The Covid catastrophe, advocates said, was not an isolated problem at the prison, but a symptom of longstanding neglect of prisoners’ health.
‘He should still be alive’
Farrar arrived at Stafford in the summer of 2021, after a short period in county jail, to serve roughly two years for a felony. His records suggest that he immediately had concerns about his medical care.
Farrar, who required four insulin shots a day, was initially given access to needles, test strips and a glucometer that measures blood sugar levels. But on 27 August 2021, he wrote to prison doctors requesting the facility give him a pump or let him access one he’d used at home for years; the small device delivers continuous doses of insulin through a catheter and can be preferable to shots for people who have frequent low blood sugar reactions. He also requested access to glucose tablets in case of emergencies.
Then, on 13 September, Farrar suffered a seizure from low blood sugar; he was found sitting in bed drooling, with his speech slurred and face drooping. Three days later, Farrar met with a doctor and again asked for a pump; the doctor wrote that the pump had enabled “good diabetic control” pre-incarceration and his family could send one. In response to Farrar’s request for glucose tablets, the doctor said he could get a “snack at night to keep in case of drop in sugar”.
The pump arrived at the facility and Farrar used it until he ran out of insulin supplies, writing on 11 October: “My supplies were paid for by my insurance company that I don’t have anymore. Is there any way the facility/department can pay for my needed supplies? Thank you.”
Staff responded a week later: “We are not able to pay for your pump supplies because the pump is personal property.”
On 3 December, Farrar wrote a grievance, a copy of which he sent to his family, saying he had again lost consciousness due to low blood sugar and requesting that the facility pay for pump supplies.
It is unclear how the prison responded. In that final complaint, 24 days before his death, Farrar said: “I don’t have the funds to buy the supplies needed … [for] my diabetes care and survival.”
On 27 December, Farrar collapsed for the final time. He had failed to show up for his insulin shot and dinner earlier that evening and was found lying on the ground by the prison phones, with blood coming from his mouth, records say. His blood sugar level was 32 mg/dL (below 54 mg/dL is considered severely low). Staff gave him one dose of glucagon, then another, to raise his levels and started conducting CPR, according to the records.
Emergency medical responders arrived 35 minutes after the emergency alarm sounded, and Farrar was declared dead 20 minutes later.
After reviewing his medical records, Farrar’s family said they believed the prison had repeatedly neglected his health, including by denying him supplies that could have prevented his seizures, failing to check on him when he did not arrive to get his insulin shot, and responding too slowly to his final emergency.
“With the pump and better medical treatment that day, Clifford would still be alive,” Farrar-McQueen said.
“He did not die of natural causes,” added Mario Farrar, Clifford’s brother, saying that Clifford had probably missed his shot and dinner because he was already struggling with low blood sugar, and arguing that staff might have saved him if they had intervened. “Negligence was the cause of everything, and I’m afraid for anybody inside there who does not show up for the medicine line.”
A DOC committee charged with investigating unexpected deaths found that a contract nurse had not been trained on emergency response procedures and equipment; that neither a suction device meant to help him breathe nor an oxygen device had functioned properly; and that staff had not been up to date on CPR trainings. The committee also said at the time of his death, insulin pump supplies “had been ordered” but had not yet been available.
Following Farrar’s death, that committee and the correctional ombuds office recommended that DOC improve its management of diabetes patients, ensure they have access to supplies and medications, establish better care coordination and communication between clinical and administrative staff, and have more consistent trainings and processes to check on the functionality of emergency medical supplies.
Chris Wright, a DOC spokesperson, said the agency could not comment on the case due to confidentiality laws but said in an email: “It is a tragedy when any incarcerated individual dies while in our custody unexpectedly, and the Department of Corrections offers its condolences to the family of Mr Farrar.”
Wright said that since Cheryl Strange had taken over as DOC secretary in April 2021, she had worked to reform prison healthcare, including by expanding telemedicine; directing staff to prioritize “timely off-site medical visits”; revamping its grievance process to target quicker responses; and recently hiring 84 new medical positions. He said DOC had brought on multiple consultants and experts to review and improve its health system and help expand access to care.
DOC had also updated its health plan to include insulin pumps as “medically necessary care for diabetics who are not well controlled on oral medications or injectable insulin”, and staff had been trained on the pumps and diabetes management, he said.
‘I’m just a paycheck’
Since Farrar’s death, people incarcerated at Stafford and advocates outside the prison have demanded changes, including the resignation of the prison’s superintendent, an external investigation of medical care at the facility, and trainings for incarcerated residents on how to provide care for those with health risks.
Michael Beshirs, 32, who has been at the prison since 2018, said Farrar’s death was “extremely appalling, but not surprising”. Beshirs said he had struggled with seizures for years and has “lost all faith in DOC”, adding: “Even with my medical condition, I’m concerned I’m just a paycheck. Staff do nothing to provide adequate medical care. Instead, they deflect our concerns hoping we’ll give up. Our rights are not made accessible to us, so asking for basic care can feel like we’re asking for the world.”
Beshirs said that a neurologist who is a DOC contractor had recommended he receive tests, including an MRI, to assess brain damage and the cause of his seizures, but that ultimately the prison declined to have him tested: “Our conditions are never addressed.”
Even after Farrar’s death and the Covid violations, Stafford has again been accused of violating health protocols. In September, the state issued a $84,400 fine against the facility, saying it was mishandling a tuberculosis outbreak and failing to take basic steps to prevent the spread of yet another infectious disease.
McQueen said she remained fearful for anyone with diabetes in DOC custody, saying the system needed better standards for monitoring residents’ health and handling emergencies.
“They don’t care about our lives,” she said. “These are preventable deaths, and we cannot allow it to continue.”
Shilpa Jindia contributed reporting
Felix Sitthivong is an incarcerated writer at the Stafford Creek corrections center who works with Empowerment Avenue. Sam Levin is a staff reporter at Guardian US.
