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Miami Herald
19 hours ago
- General
- Miami Herald
When tenants have a right to counsel in eviction cases, but there aren't enough lawyers to help
When tenants have a right to counsel in eviction cases, but there aren't enough lawyers to help Icy snow crusted the sidewalks outside the Bronx housing courthouse on a Thursday in late January, a bitterly cold day in a string of bitterly cold days. Inside, spread out over three floors, dozens of people in puffy coats, some cradling babies or hunched over canes, waited to find out whether they would be kicked out of their homes or what it would take to stay housed. Every few minutes, a lawyer or court employee exited one of the courtrooms and shouted a name down the hall, searching for whoever was needed to proceed with an eviction hearing. Even more people were crowded inside the hearing rooms on each floor. Inside Room 550, around 11 a.m., a man in a black-and-white tracksuit and gold chain sat next to a woman in a sweatshirt and jeans who was wiping away tears. They faced a judge with long black twists and large, round glasses. No lawyer was with the couple, only the court's Spanish-language interpreter, in a blue suit and neat gray beard. Their landlord wasn't in the room, either; the landlord's attorney was there instead, texting and stepping into the hallway to talk to his client on the phone. The couple was trying to move back into the home they'd been evicted from, but the judge denied their request, informing them that they had to remove all their belongings within five days. "Good luck," the judge said at the end of the proceedings. The next defendant, a Black woman dressed all in black, had accumulated $27,849 in outstanding rent; she was given until the end of February to pay it off, plus the next month's rent. If she paid up, then the case would end, the judge told her. But if not, the landlord would have the right to seek an eviction warrant. Because she had no lawyer to help her parse the proposed deal, the judge had to stand in to make sure she could legally agree to it. Did she understand that she was waiving her right to a trial? Yes. Was she coerced into entering into the agreement? No. "Good luck, ma'am," the judge told her. "Thank you," she said softly as she left. For a brief time in the depths of the pandemic, the hallways and courtrooms of this courthouse had sat empty; eviction moratoria kept most cases from moving forward, and any that did proceed happened online only. But those measures are now long gone, and courts across the city have filled back up. "Housing court is like what it was before," said Munonyedi Clifford, attorney-in-charge of the citywide housing practice at The Legal Aid Society. Yet one key thing has changed: All of these tenants are, by law, supposed to have legal representation at their side. As the late January proceedings in Room 550 would prove, however, that right on paper has not prevented thousands of people from facing eviction all by themselves. Economic Hardship Reporting Project and The Baffler examined the high number of eviction cases in New York City, in which most tenants have no legal help despite residents' right to counsel. Other jurisdictions that have passed similar laws should pay attention to New York's current predicament. The unrepresented This isn't supposed to happen in New York City. In 2017, it became the first place in the country to enact a right to counsel in eviction cases, a guarantee of legal help for tenants navigating the process. In much of the rest of the country, just 4% of tenants have lawyers at their sides in eviction cases, compared to 83% of landlords. This creates a "huge imbalance," according to Peter Hepburn, associate director at The Eviction Lab, a research project at Princeton University, "not just in terms of power but just of procedural knowledge." Landlords find themselves in eviction proceedings frequently, and their attorneys deal with it daily. "The system works very well for them," Hepburn said. For tenants, eviction yanks them into an unfamiliar and often confusing world of legal maneuvering. "It doesn't work so well for them." New York City's landmark Universal Access to Legal Services law-codifying the right to counsel-was designed to fix this imbalance for households earning up to 200% of the poverty line, or $64,300 for a family of four. It started in just three zip codes per borough and was supposed to expand gradually, with five new zip codes added each year for five years, until the entire city would be covered. Before the pandemic began, right to counsel applied to only 25 of the city's 180 zip codes. The program quickly proved successful. Research published in a June 2023 issue of the Journal of Public Economics found that tenants who got legal representation through the program faced smaller monetary judgments and were less likely to be evicted. For tenants lucky enough to have representation in court in 2023, 84% percent were able to stay in their homes. The program has also reduced the number of eviction filings in the first place. "There's no question that the right to counsel works," Clifford said. After COVID-19 hit, the city's program was abruptly opened to all low-income tenants in early 2021 in an effort to keep people housed and healthy. At the time, caseloads were low, thanks to eviction moratoria, and in early 2022, close to 70% of tenants facing eviction were represented by an attorney. But after the CDC's nationwide moratorium was struck down in August 2021, and New York City's version ended a few months later, the floodgates were flung wide open. Stalled eviction cases started to move forward just as landlords filed a flurry of new ones: Eviction filings jumped 83% between 2022 and 2023. "It's back to business as usual," Clifford said. As a result, things quickly deteriorated. The percentage of tenants represented by an attorney declined steadily after January 2022. According to a paper written in 2023 by 11 legal services organizations, the right-to-counsel program has been plagued by "client eligibility outstripping provider capacity, funding shortfalls, and staff attrition, while tenant needs continue to rise." There were 111,830 eviction filings across the city last year, compared to just 42,203 in 2021. The Bronx is consistently the hardest hit, experiencing an eviction rate double that of the other four boroughs. And the majority of those Bronx tenants go it alone. In the fourth quarter of fiscal year 2024, only 42% of people facing eviction in New York City received full legal representation, while about half had no legal help at all; in the Bronx, less than a third were fully represented, while about 60% went through eviction proceedings by themselves. When a New York City tenant receives an eviction notice, they must reply to avoid automatic eviction. Their response triggers an "intake part," or IP, date. That's where, if they're lucky, they'll be assigned a legal aid lawyer who can help them. But there are 80 households at each IP date, which are held over Microsoft Teams for cases in the Bronx, and legal aid lawyers "just don't have the capacity" to cover all of them, said Jennie Stephens-Romero, deputy director of the housing unit at Bronx Legal Services. Her organization and the five others that offer free legal help to tenants facing eviction in the Bronx use a calendar system to make sure that one of them covers at least some of each weekday's IP date. Stephens-Romero's team was "very big," but they could only cover part of their assigned day; for a while they were able to cover either the morning or the afternoon, but after staff departures, they can only take on the first 20 tenants on their given day. Other organizations, she imagines, can take on even less. "It's really luck of the draw," she said, as to whether a tenant's IP date corresponds with the part of the day when attorneys are able to tune in and help. Everyone else is left to fend for themselves. It's "incredibly rare," Stephens-Romero said, for a tenant facing eviction to be able to afford their own lawyer without the help of a legal aid attorney. Last year, 11,587 tenants without representation called The Legal Aid Society's hotline (some may not be eligible for the right to counsel, and others may get a lawyer later in the process). Stephens-Romero said it's unusual for her to come to housing court and not be approached by somebody asking how to get a lawyer. Post-pandemic flood There doesn't seem to have been any planning for what would happen when the housing court system returned to its pre-pandemic state. Right-to-counsel lawyers in the city quickly realized that they couldn't handle all of the cases for eligible tenants; they didn't have adequate funding to meet the demand. So they, along with elected officials, asked housing judges to issue adjournments and postpone cases for tenants who weren't yet represented to give them time to get an attorney. The courts refused. "Courts are totally aware legal service providers can't handle all these cases," Stephens-Romero said. Indeed, as Community Service Society of New York policy analysts Oksana Mironova and Yvonne Peña write, courts are "choosing to move cases faster than the legal services providers can take them on, prioritizing speed over the tenants' right to due process." These priorities are precisely backward, Stephens-Romero said. "We're pushing tenants' rights to the side to clear the docket." Meanwhile, New York City's right-to-counsel program has only expanded further. In 2023, eligibility was extended to anyone of any income age 60 or older facing eviction. Legal service providers calculated that they needed $16 million a year to be able to handle those new cases-an alarming number, as the program wasn't fully funded even before that expansion. In 2023, legal aid providers told the city that it would take at least an additional $351 million to adequately serve the tenants they were already taking on plus all of the qualified tenants who were estimated to go through the process solo in 2024. Yet legal services providers in the city were granted only an additional $36.6 million for this work last year, and even then, the Eric Adams administration failed to pay out the money on time, forcing some organizations to contemplate cutting the help they offer. This is despite the fact that an analysis found in 2016 that the city would actually save $320 million a year in foregone shelter and housing costs by providing tenants with attorneys in eviction cases. "We want the right to counsel to really have the true meaning of what the tenant movement and folks who fought for this right really wanted, which is that everybody will get it," Clifford said. "But the city doesn't seem to be putting resources toward that kind of idea." More funding could also ease the staffing problems plaguing legal services organizations. Of the $351 million that these organizations have asked for, $226 million would go toward hiring more than 880 staff attorneys, a badly needed influx. Public interest lawyers face crushing workloads on salaries far lower than what they could command at private practices. In 2023, legal aid organizations reported attrition rates ranging from 20 to 55%; one provider lost six of 13 new hires within a year. "This is a tough job," Stephens-Romero said. If caseloads could be brought down and salaries increased, more people might stick around. The state court system released a report in 2023 recommending that attorney caseloads be limited to 48 a year. That represents an improvement from what caseloads used to be; Clifford said lawyers were routinely taking on more than 60 a year. But it's still a high number, according to Stephens-Romero, especially when some can be lengthy. Housing laws "are pretty complicated and complex, and each housing case requires a tremendous amount of work," Clifford said. Legal service lawyers wouldn't have to work so hard, however, if there weren't so many eviction cases inundating the system to begin with. As much success as the right-to-counsel program has shown for the tenants it's able to reach, New Yorkers would be much better off if they could simply stay housed in the first place. Yet New York City has long struggled to build and provide affordable housing, and the housing crunch is now the worst it's been in 50 years. "So many people wouldn't be ending up in housing court if apartments were eminently affordable," Clifford said. The city could also offer more help covering rent. Vouchers, which help low-income tenants afford apartments on the private market, are notoriously hard to use: The eligibility limits are stringent, and although it's illegal for landlords to refuse to rent to voucher holders, many do in practice. But the city has struggled to make improvements. In 2023, the city council overrode Mayor Eric Adams' veto to expand eligibility for some voucher programs, but Adams refused to implement the expansion, claiming it was too costly. After the city council sued over his refusal, a judge sided with Adams last summer. Other attempts to protect tenants might prove more successful. New York State approved good cause legislation for the city in 2024, which, for covered buildings, caps rent increases and bans landlords from evicting tenants except for things like nonpayment of rent or illegal behavior. But the law has a number of carveouts, including for buildings constructed after 2009, luxury units, rentals in condos and co-ops, and those owned by landlords with small portfolios. The hope, Clifford said, is that the law will eventually push the number of eviction filings down. "It's not everything that we wanted," Stephens-Romero said. But "it's definitely something we can use." Going national The early success of New York City's right-to-counsel program inspired other lawmakers around the country. "It basically made right to counsel seem achievable for lots of places," said John Pollock, coordinator at the National Coalition for a Civil Right to Counsel. In the three years after New York City enacted its program, four other jurisdictions-Cleveland, Philadelphia, Newark, and San Francisco-passed their own. Then the pandemic, which exposed not just the way job loss deprives people of the income to pay rent but also the impact of housing on people's health, lit a spark. Since the start of 2020, 14 cities, two counties, and five states have passed programs. Three states and six cities added their programs in 2021 alone. That frenzy has calmed down, but "we're still seeing the momentum rolling forward," Pollock said. These jurisdictions, and any others that join in, will have to heed the lessons of New York. Funding is one of the biggest question marks for other right-to-counsel programs, too. Many were set up with pandemic-era federal aid, money that has all been disbursed. When Hepburn and his colleagues at the Eviction Lab recently interviewed people working on implementing all the right-to-counsel programs across the country, "underfunding was something that came up throughout," he said. Still, Pollock hasn't seen any jurisdiction renege on its right-to-counsel program even as federal funding has dried up, and many are turning to their own sources to keep it going. In Hepburn's research, he and his colleagues found that thirteen programs are supported by state and local funding, including four that have their own revenue streams from things like taxes on landlords or developers. But even if programs were flush with cash, there is still a shortage of lawyers interested in and willing to do this work. "This is a sector-wide problem," Pollock said. Fixing it, as in New York, will take not just enough funding to make salaries competitive and workloads bearable but also a steady pipeline of new lawyers ready to go into housing law, which some law schools don't even cover. Then there are the court systems themselves, which have appeared to resist slowing things down to make sure tenants get the legal representation that they're due. "That approach of continuing cases when lawyers are not available, making tenants go through when unrepresented, that's a huge part of the problem," Pollock said. Courts tend to favor the interests of landlords. But in Washington State, judges are required to delay a case if a tenant who is eligible for the right to counsel appears solo. "Courts could take a different approach. They're choosing not to," Pollock said. He pointed out that, at less than 8 years old, the movement for the right to counsel in eviction proceedings is a relatively new one. "As with any movement, you expect there are going to be challenges," he said. But if New York wants to retain its status as a leader, it will have to pave a path toward finding the resources and the political willpower to make a groundbreaking right mean something real for everyone to whom it's owed. Pay up None of the half dozen Bronx tenants who were called before the judge in Room 550 over the course of an hour on that morning in late January had a lawyer helping them make sense of the process. A woman with the court's Spanish interpreter and no one else by her side was told she had to pay $3,554 by the end of February to avoid an eviction warrant. A white-haired man, also accompanied only by the translator, had accrued $2,221 in outstanding rent; the eviction warrant against him would be put on hold, the judge said, if he paid his February and March rents on time. "Good luck sir," she told him. Another woman, her dark hair tied up in a bun, sat next to her landlord's attorney. She owed $24,660 in outstanding rent. She was told, with the help of the interpreter but no lawyer, that her warrant would also be put on hold if she paid by the end of February. Last was a man who had accumulated $5,395 in outstanding rent; he had nine days to pay $3,200, plus the following months' rent, in order to stave off his eviction warrant. He, too, faced the judge alone. These judgments represent staggering amounts of money for most low-income renters. Many of Stephens-Romero's clients are "in really dire straits," she said. A large number have physical and mental limitations that prevent them from working, while others struggle to find jobs, or at least ones that offer enough hours and pay to make rent. If the tenants in Room 550 had had a lawyer on their side, they would likely have pushed back against the judge and managed to lower the amounts that their clients had to pay, or at least bought them more time. None of the tenants had the capacity to argue on their own behalf. Instead, they all accepted the sums that were handed down, whether they could afford them or not. Right to counsel "is a law," Stephens-Romero said, "and we aren't meeting it." Co-published by Economic Hardship Reporting Project and The Baffler. This story was produced by Economic Hardship Reporting Project and The Baffler, and reviewed and distributed by Stacker. © Stacker Media, LLC.
Yahoo
4 days ago
- General
- Yahoo
Communities across US struggle with new threats emerging beneath their feet: 'When you walk, you feel like you're on jelly'
Areas everywhere are being reshaped by rising global temperatures and their effects. But from Alaska to Louisiana and beyond, Indigenous communities are among those experiencing some of the first and most devastating impacts. In the podcast Sea Change, New Orleans Public Radio and Baton Rouge Public Radio, in collaboration with the Economic Hardship Reporting Project, recently addressed the growing and disproportionate threats of climate change on some of the Tribal lands in the United States. Indigenous people, especially those living in coastal areas, are being displaced by extreme weather and rising seas. Even in between increasingly destructive storms, everyday existence in these communities isn't what it used to be. Nunapitchuk, Alaska, resident Gertrude Lewis described what it can be like just walking around her Native village since the permafrost has been thawing: "My grandson, he stepped off the boardwalk and he went knee deep. We had to pull him out — we lost his rubber boot." Sharing the Yup'ik word for the feeling, she said, "Angayiiq — it's like where you when you walk you feel like you're on jelly." Having spoken with Morris Alexie, also Yup'ik and in the midst of considering how he will help to migrate his village to firmer ground, the radio report also explains that "the boardwalks in Nunap dip and curve as the ground thaws and unevenly degrades below them … As the permafrost thaws, it also increases riverbank erosion, literally eating away land from underneath the village." Tribal communities are often located in areas already facing some of the most damaging and visible impacts of our warming world — places like the melting Arctic and islands shrinking as sea levels rise. Historically oppressed throughout much of the globe, many Indigenous groups have already been robbed of their lands by colonization, only to face further threats of displacement as thaws and floods threaten the safety of their homes. They have also often been robbed of generational wealth and marginalized from other resources, making survival even more tenuous. This can be especially true as so many Tribal cultures, food sources, and livelihoods — hunting, fishing, berry picking, nature arts like basketry — are interconnected with increasingly imperiled ecosystems. In Alaska, where Lewis and Alexie live, thawing permafrost is a significant cause for concern. In Louisiana, it's rising sea levels, where coastal erosion and saltwater intrusion are displacing the Pointe-Au-Chien Indian Tribe and causing their land to disappear. Indigenous people face continued uncertainty as they lose their ancestral lands — their homes and traditions — to the planet's steady it's the traditional wisdom from these communities that may offer some of the most promising keys to climate resilience for all. As the United Nations Development Programme has noted, Indigenous knowledge can provide insights into drought-resistant crops, sustainable water management practices, and responsible land stewardship. Do you think America is in a housing crisis? Definitely Not sure No way Only in some cities Click your choice to see results and speak your mind. Funding research and implementation for related projects could help more people benefit from this expertise while properly compensating Indigenous experts. And supporting pro-environment land-back policies has the potential to protect vital ecosystems and Indigenous communities all at once. Taking a traditional approach to understanding today's most critical climate issues might involve appreciating the interconnectedness of all things. And it can inform doable actions and daily choices with a climate benefit, like reducing meat consumption, patronizing local farms, shopping secondhand, and switching to renewable energy sources like home solar power systems. Join our free newsletter for good news and useful tips, and don't miss this cool list of easy ways to help yourself while helping the planet.
Miami Herald
02-06-2025
- General
- Miami Herald
Saving sinking homes
Saving sinking homes Stephanie Alexie awoke one morning to find her home surrounded by water too deep to wade through. "It looked like the ocean," she recalled. Neighboring houses appeared barely suspended on top of rippling blue pools-mirrors reflecting the clear sky. In the distance, the wooden boardwalk built over marshy tundra dropped off into a vast sea. Alexie and her children were stranded until neighbors came by with a boat to her corner of Nunapitchuk, a Yup'ik village of roughly 550 people. The land Alexie's home sits on never used to flood. But, in the last few years, seasonal transitions in the Yukon-Kuskokwim Delta-an area of western Alaska where the state's two longest rivers empty into the Bering Sea-have become more disruptive. Now, every spring, when the region undergoes a great thaw and chunks of ice break free from frozen rivers, Alexie finds herself sitting on an island. Alexie's home survived the May 2020 floods, which were the worst the village had experienced in years. But, floodwaters rose dangerously close to the building's foundation, rotting the insulation underneath its floors. Black mold-likely a result of moisture trapped in the home-bloomed across the kitchen ceiling. Alexie worried about where she and her family would go if the home became uninhabitable. It already felt like it was bursting at the seams: 26 people shared its four bedrooms. Mattresses with dozing children lined the living room floor. And toys and clothes spilled out of closet doors into the hallway. "There were too many things and no room," she described. Alaska is home to 40% of the country's federally recognized Tribes, nearly half of whose members are based within roughly 200 villages in rural Alaska. These Alaska Native communities are diverse in culture and geography, but share a common risk: Alaska is warming two to three times faster than the global average. A 2024 assessment by the Alaska Native Tribal Health Consortium found that 144 of these Tribes were facing some form of erosion, flooding, permafrost degradation, or a combination of all three. The Economic Hardship Reporting Project and The Nation have investigated how those environmental changes have contributed to a severe housing shortage in western Alaska. In Nunapitchuk, for example, water damage during the 2020 floods rendered several homes uninhabitable, forcing some displaced residents to move in with friends and family, increasing already-high rates of overcrowding in the village. Alexie thought about moving back to Bethel, a city of more than 6,000 and the largest in western Alaska, which also serves as the hub for the 56 villages in the Yukon-Kuskokwim Delta region. Although there is more available housing there, in Bethel, it would be more difficult to access the same traditional subsistence lifeways they practice in Nunapitchuk. In the absence of meaningful government assistance, residents have taken extreme acts of adaptation to stay on their ancestral lands, from dragging houses across the tundra to safer locations to moving into already crowded homes. As governmental neglect persists and climatic shocks worsen, Alaska Native communities worry it will be increasingly difficult to maintain safe shelter and keep their Tribes together. "We just have to live through it even though we don't get any help," Alexie said. The legacy of 'sick homes' Prior to prolonged contact with settlers and missionaries in the late 19th century, Indigenous peoples in western Alaska lived semi-nomadic lifestyles. Based on subsistence needs, Tribes might have moved from the coast in the spring, to riverside fish camps in the summer, to the tundra for black and whitefish trapping in the fall, and ice fishing in the winter. This mobility offered protection: People moved frequently to adapt to changes from flooding and erosion. Starting in the late 19th century, roaring waves of economic development brought an influx of settlers and boom-town investment. During the gold rushes in northwest Alaska, the federal government invested in schools as a tool of colonial control, in hopes that Native children "might find viable economic and social roles to play in western society," as described in a 1996 book recounting the history of education of Indigenous peoples in circumpolar regions. Settlers and the U.S. government positioned schools as crucial hubs for medical care and sanitation, with some also offering religious services, food, and clothing. These offerings, coupled with mandates for compulsory school attendance, pushed Alaska Native peoples to settle permanently around newly constructed schools. As a result, land that Tribes may not have found suitable for long-term habitation became the locations of many modern-day villages. In western Alaska, people settled along wetlands, marshy tundra, and rivers-where they frequently camped for ease of hunting and fishing. Decades later, these fragile waterside ecosystems have become bellwethers for the climate crisis. When temperatures warm in the spring, melting snowpack restores flowing river channels, plentiful lakes reemerge and trails become soggy. This "breakup season" ushers in a short subarctic summer, when the tundra transforms into muddy wetlands, reviving salmonberry shrubs and opening new opportunities for subsistence hunting and fishing. These days, snow melts earlier than ever before, and erratic temperature swings in the spring can unleash sudden deluges. Rapid breakup of ice hastens erosion along riverbanks. Although breakup season typically brings some flooding along riverbanks, more extreme floods, such as the ones affecting Nunapitchuk, are now more common. The warming climate warps life in western Alaska year-round, too. Freeze-up comes later in the fall, restricting traditional winter travel routes along frozen rivers and across sea ice, and consequently limiting access to fish, seals, whales, walrus, and other important subsistence resources. Fall storms are increasing in frequency and strength. In September 2022, Typhoon Merbok, born out of warmer-than-usual waters in the Pacific, pummeled western Alaska. Forty communities in the region were damaged, with losses to homes and fish camps, according to a government tally in the month of the storm. From 1953 to 2017, the number of federally declared disasters in the state increased dramatically, with the majority of these events caused by flooding or severe storms in the Yukon-Kuskokwim Delta region. And, as western Alaska has become wetter and warmer, once-frozen ground is sinking. Permafrost-the ice-rich soil that rests below the surface of roughly 85% of Alaskan land-is rapidly thawing. That phenomenon is projected to cost billions in infrastructure damage and is already increasing upkeep costs for homes that are losing their structural integrity as the ground below lurches. Worse, the effects of climate change-erosion, flooding, and permafrost thaw-don't always appear in isolation. They often amplify one another, leading to major land collapses, known by the Yup'ik term usteq. Natalia "Edna" Chase, a 60-year-old Yup'ik woman, moved into her Nunapitchuk home with her family when she was 2 years old. When it was built in the late 1960s, the house sat high off the ground on wood stilts-a structural feature intended to prevent the home's heat from thawing the permafrost below. As long as permafrost remains frozen, it can support homes and infrastructure. With rising temperatures, however, this frozen soil is degrading rapidly, transforming solid ground into muddy sinkholes and swallowing Chase's home. Each year, the home sinks 6 inches. When the marshy land engulfed the original flooring from her childhood home, Chase laid another floor on top. Soon, both were entirely underground. Chase's house, crookedly descending into the earth, is now supported by layers of plywood she built haphazardly on top of the sunken floors. Like Alexie, Chase was also affected by the 2020 Nunapitchuk floods. Water inundated her house, and she bailed out over 100 gallons. The flooding accelerated permafrost degradation underneath the building, according to Chase. Since then, conditions in her home have gotten exponentially worse. Her floors warp at steep angles. Whenever it rains or snow melts, the home floods. Last year, Chase tried digging a culvert under the building to drain floodwaters. A foot and a half underground, she hit permafrost, signifying what she already knew to be true-that the building was rotting from the ground up. "So if I want to build a house, it's not gonna be here," she said. As the ground shifts, the joints between her walls and floors split open. Every week, despite her chronic back pain, Chase moves all her appliances and furniture away from the walls to seal the cracks with a fresh layer of duct tape. But these are only stopgaps. Homes like Chase's were never equipped to survive in Alaska's extreme climates. Instead, developers constructed them hastily, and with little consultation with local residents, while riding the oil revenue booms of the 1970s. The discovery of oil in Alaska's North Slope in the 1960s set off fierce lobbying for the Trans-Alaska Pipeline project, which was the largest private-capital project in world history at the time. The resulting pipeline boom drastically altered life across the state, especially for Alaska Native communities. Oil companies sought control over vast swathes of land in order to begin oil drilling. They pushed for the passage of the Alaska Native Claims Settlement Act in 1971, which extinguished all Indigenous land claims across the state; in exchange, Alaska Natives received roughly $1 billion and 44 million acres of land. In a departure from the reservation system in the contiguous United States, the federal government conveyed these lands to newly established Alaska Native corporations. The Alaska Native Claims Settlement Act secured the future of the Trans-Alaska Pipeline, effectively creating a "pipeline right-of-way through the center of Alaska," according to Philip Wight, an assistant professor of History and Arctic and Northern Studies at the University of Alaska Fairbanks. It also inextricably linked Indigenous land sovereignty to oil development, and further consolidated Tribes in permanent villages by forcing them to lay claim to specific portions of land via Native corporations. The state of Alaska reinforced these permanent villages through investments in infrastructure. Massive amounts of oil revenue enabled the state to construct housing at an unprecedented rate; over half of Alaska's current housing stock was constructed during the 1970s and 1980s. Many homes in Indigenous villages-including Chase's home-originated in this industry-fueled housing boom. The speed and scale at which these homes were constructed had consequences. Much of this housing development ignored centuries of Indigenous wisdom on which structures are most resilient in climates of extreme cold. Developers modeled many homes after those typical in the temperate continental United States, erecting California ranch-style houses across the tundra. Decades later, these houses are deteriorating rapidly. "That has a lot to do with the current housing crisis, frankly, and it has a lot to do with the health issues we've seen with housing," said Ryan Tinsley, a Fairbanks-based construction expert. Tinsley has been advocating for more adaptable housing models in Alaska with his wife, Stacey Fritz, an anthropologist who formerly worked with the Cold Climate Housing Research Center. Older homes built in the 1970s and 1980s had thin, uninsulated walls that offered poor protection from subarctic cold temperatures. Weatherproofing processes attempted to fix these issues by adding insulation and sealing leaks, but failed to install proper ventilation. As a result, a 2018 statewide housing assessment estimated that more than half of Alaska's households lacked the ability to properly remove moisture and indoor pollutants from their homes. In such indoor environments, the health of the occupants suffer. "Many, many people we've interviewed have called [modern homes] sick homes," Fritz said. Alaska Native communities suffer from respiratory diseases at high rates; in the Yukon-Kuskokwim Delta region, children are hospitalized for RSV, or respiratory syncytial virus, at rates up to seven times that of the national average, according to a 2023 study published in the Pediatrics journal. And climate change is making indoor air conditions worse, as ambient temperatures and moisture levels increase, and wildfire events become more common. Chase's household has been living with long-term health consequences since their home sustained damage in the 2020 floods. Her 15-year-old son started using an inhaler, and her former partner, who was living with her at the time of the flooding, developed chronic obstructive pulmonary disease, or COPD, a lung condition that causes breathing difficulties. No matter what she does, she can't seem to prevent moisture from seeping in, sending mold-green, then black-up the walls of the house. "That stench on my clothes can never come out, that mildew smell," she said. 'We're not getting the help that we need' On an overcast March afternoon, Simon Lawrence drives on the Kuskokwim Ice Road. Parking just east of Kwethluk, a Yup'ik village about 30 miles inland from Nunapitchuk, Lawrence gestures out the window at an opening of the Kuskokuak Slough, a tributary of the Kuskokwim River. Just three decades ago, village children could safely hop over the narrow gap and play in its shallow waters during the summer, Lawrence recalls. Over time, erosion has deepened the channel, widening the gap between its banks and redirecting powerful currents toward the village. At age 55, Lawrence has spent almost half his life working in maintenance in Kwethluk's local education system. When he built his two-bedroom house in the early 2000s, he thought sitting it on the higher ground uptown would shield it from flooding. But now, the eroding river channel is inching westward toward a small stream connected to the heart of the village. When the two bodies of water inevitably meet, the resulting oxbow will likely unleash an outpouring of river water on Kwethluk's uptown. The floods could engulf several homes, including Lawrence's. This isn't the first time that changing river conditions have threatened housing. A few years prior, the advancing riverbank forced Kwethluk to apply for federal funding to tow four of its homes inland. The village needs to move four more buildings that are within 15 feet of the water, but are struggling to find funding. The equipment and personnel required for the relocations are costly. Even gathering the data to demonstrate climate-related threats, which is a requirement for many government funding requests, is an expensive task. The Alaska Native Tribal Health Consortium estimated in its 2024 report that this would cost $20 to $30 million for the 144 threatened villages across the state. When scarce federal resources are being spent on moving and repairing homes, local housing authorities are redirecting funds that normally go to new development. Maintaining safe homes in increasingly extreme and unpredictable environmental conditions is costly, but also increasingly necessary. "The reality of their climate is changing faster and more harsh[ly] than anybody expected 20 years ago," said Brian Wilson, the executive director of the Alaska Coalition on Housing and Homelessness. "The upkeep budget gets more and more expensive, which then also makes it so you can't build as many homes." And, even when housing authorities build new homes, volatile weather swings can interfere with construction that is already confined to a short season. Rural villages like Kwethluk are off of Alaska's road system. In warmer weather, people arrive by boat on the Kuskokwim River. And, when subzero temperatures hit, local crews plow a seasonal road averaging 200 miles over the thick river ice. Building materials are delivered to Kwethluk via river barges in the limited summer months. To get to the village, lumber and steel must travel through Seattle, Anchorage, and Bethel first. By the time they arrive, it's late summer's rainy season. And crews scramble to put the homes together before freezing temperatures set in. Global warming brings a wetter environment-and an increased incidence of precipitation events, such as freezing rain-that can disrupt these already-tight schedules. To alleviate these pressures, one of the former directors of Kwethluk's housing program wanted to build a facility in which homes could be fabricated. This manufactured housing system would enable prefabricated homes to be assembled year-round, regardless of weather conditions. "He had a good vision. If we had funding for that building, I would say go for it," said Chariton Epchook, Kwethluk's Tribal administrator. "Funding is what holds us back from the things we want to do." Epchook said the region's housing authority is already stretched thin. Access to funding is a particular challenge for Native communities living in rural Alaska, who are disproportionately low-income. Indigenous people in Alaska experience poverty rates nearly triple that of white Alaskans, census data shows. And poverty is the highest in rural, predominantly Native areas of the state: In one western Alaskan village of Alakanuk, nearly 40% of residents live below the poverty line. In many rural areas, people depend on subsistence harvesting-not just for survival, but to maintain culturally and spiritually important practices, too. Public funding is therefore crucial for maintaining infrastructure and services in villages. Many residents rely upon affordable housing units to remain in their village. Even for higher-income families that can afford market-rate rent or homeownership, the high cost of construction in remote villages disincentivizes private developers from investing in new homes. The majority of construction for affordable housing for Alaska Natives in villages today is funded through the Department of Housing and Urban Development's Native American Housing Assistance and Self-Determination Act programs, which were passed in 1996 to address housing gaps in Indigenous communities. Since the law went into effect, the program's funding has been used to build or acquire almost 41,500 affordable homes and restore an additional 105,000 affordable homes on Tribal lands and in Alaska Native communities. Funding levels, however, are subject to political whims and have remained largely stagnant. Until the 2024 fiscal year, inflation-adjusted dollars for the Native American Housing Assistance and Self-Determination Act's housing grant program remained below levels from fiscal year 2000. That means fewer houses have been built in the last two decades. That decline in available resources can be seen clearly in a coastal Inupiaq village north of Nunapitchuk. In Brevig Mission, a village outside of the hub community of Nome, the Native American Housing Assistance and Self-Determination Act funded 20 houses in the late 1990s, but in recent decades, it has barely covered the construction of five homes. The Bering Straits Regional Housing Authority, headquartered in Nome, serves Brevig Mission along with 17 other communities. The housing authority estimated in 2022 that Nome and its surrounding villages need about 400 new homes over the next 25 years. However, the housing authority only delivers about three new homes each year. Building one costs about $780,000, said Jolene D. Lyon, president and CEO of the housing authority in the Bering Strait region. Lyon and her staff also have to balance the logistical puzzle of constructing new homes with the upkeep of already existing ones. In Brevig Mission, for example, the severity of permafrost thaw has come as a surprise. Homes are sinking several feet. Water and sewer lines are pulling away from their hookups and creating mini glaciers. Windows are warping. "The 20-plus homes that we leveled last year need to be re-leveled again," Lyon said. "I cannot afford to do that every year…I don't have that kind of funding allocation." In other words, the climate crisis is exacerbating the funding squeeze for housing agencies. "Those changing terrestrial processes, whether it's permafrost degradation and thaw, whether it's erosion and flooding, that's all coinciding with a time where we have fewer resources than ever, at least at the state level, to put toward these kinds of projects," summarized Griffin Hagle-Forster, the executive director of the Association of Alaska Housing Authorities. And now, with frenetic federal funding freezes, even more projects-including several intended to proactively protect villages at risk for major climate hazards-are in jeopardy. Genevieve Rock coordinates mitigation efforts against climate impacts for the Tribal government in Shaktoolik, an Inupiaq village of around 200 on a narrow spit of land along Norton Sound, an inlet of the Bering Sea. The community was already considered one of the state's most threatened by climate change; that existential threat became even more urgent after Shaktoolik lost its protective berm in the 2022 typhoon. The community also has a prospective relocation site further inland with a potential water source and enough land to sustain a village. But in the near term, the village badly needs a safety access road and emergency shelter so that residents are not stranded when the next storm comes, Rock said. Much of Rock's time is spent applying for competitive federal grants from entities like the Environmental Protection Agency to attempt to meet those needs. "We're all competing against each other for federal funding, and that is just not our way," Rock said. "In our Native culture, we're a kind, caring, supportive, loving group of people that support each other. I have relatives over in Shishmaref, and that's miles and miles away, but now I have to compete against my relatives over there for federal funding to save all of our lives, and that's not right." There is no federal agency solely devoted to addressing the climate threats these communities are facing. As a result, solutions are emerging in a patchwork, and Rock said she often finds herself in a catch-22. Shaktoolik needs critical infrastructure, but federal agencies don't want to fund new construction in areas that may soon be underwater. Meanwhile, Federal Emergency Management Agency disaster funds are restricted to help with individual disasters, rather than the slow-moving disaster of climate change. "We're not getting the help that we need," Rock said. Co-published by Economic Hardship Reporting Project, The Margin, and The Nation. This story was produced by Economic Hardship Reporting Project and The Nation, and reviewed and distributed by Stacker. © Stacker Media, LLC.
Yahoo
23-05-2025
- General
- Yahoo
Hawaiian taro takes root in Oregon
In the Kumulipo, the Hawaiian creation story, the goddess Ho'ohōkūkalani gives birth to a stillborn son, who is buried in the fertile soil. In her grief, she waters the soil with her tears, and a sprout emerges, becoming the first kalo plant. This plant nourishes her second-born son, Hāloa, the first Native Hawaiian. For Native Hawaiians, kalo, also known as taro—a tropical plant prized for its starchy, nutritious, rootlike corm as well as its leaves—is not just a traditional food source but an ancestor, symbolizing a lasting and reciprocal connection to land. As a staple crop, kalo has sustained Pacific Islander cultures for generations. Now kalo has sprouted thousands of miles from its ancestral home in the Portland, Oregon, metropolitan area, where a growing Native Hawaiian population resides. The land for the garden—or māla, in Hawaiian—started with just 6 square feet but has expanded exponentially, with multiple locations. What these gardens produce is more than just food and a bond with Indigenous culture; it is a thriving community, the Economic Hardship Reporting Project and Civil Eats report. "We give a safe space for our Hawaiian families," said Leialoha Ka'ula, one of the garden project's founders, describing its greater purpose. "It [is] also food sovereignty, that relationship to ʻāina, or land. It's a place of healing." Ka'ula, like many Native Hawaiians and Pacific Islanders (NHPI), left the islands due to the high cost of living there, combined with low wages and lack of jobs and housing. It's part of a pattern that followed the illegal overthrow of the Hawaiian Kingdom in 1893 and declaration of statehood by the U.S. in 1959. Then as now, emigration is fueled by unaffordable living costs, low-wage jobs, and a housing crisis driven by tourism, luxury development, and an influx of mainlanders. In 2020, the U.S. Census reported that, for the first time, more Native Hawaiians live in the continental U.S. than they do in Hawaiʻi, with Oregon having nearly 40,000 NHPI residents. Many in the diaspora long for stronger ties to their home and cultural identity. According to Kaʻula and others, the relationship with kalo is binding, and without it, Native Hawaiians lose vital connections to their culture and mana, a Hawaiian term for spiritual and healing power. But growing kalo is not as easy as just planting it in the ground. Cultivation took years of effort and help from multiple hands. Born on Oʻahu and raised on Hawaiʻi Island, Kaʻula was steeped in Hawaiian culture through her family. Her grandmother introduced her to the Hawaiian language when she was little. Wanting to continue those studies, she attended a Hawaiian immersion charter school, where she also learned cultural practices like hula, chanting, and the traditional farming methods of her ancestors, including how to grow kalo. Kaʻula came to the Pacific Northwest in the early 2000s to study psychology at Washington State University and eventually settled in Beaverton, Oregon. From her first days in Washington, Kaʻula dreamed of growing kalo there, but accessing land was a challenge. Meanwhile, she started a hula academy in Beaverton to help carry on the traditions of her elders. She also helped found Ka ʻAha Lāhui O ʻOlekona Hawaiian Civic Club (KALO HCC), one of several such clubs across Hawaiʻi and the continental U.S. promoting Native Hawaiian culture, advocacy, and community welfare after the dissolution of the Hawaiian Kingdom. Kaʻula envisioned growing kalo through the Civic Club as a part of a new youth program, but it wasn't until she met Donna Ching, an elder at the hula academy, that plans began to take shape. Ching, also Native Hawaiian, served on the board of the Oregon Food Bank (OFB), which has gardens where immigrant communities can grow culturally important foods. Ching helped secure a modest plot for the youth program in the Eastside Learning Garden, in Portland—and the kalo project was born. The next step was to ensure a blessing for the māla. KALO HCC invited Portland-area Indigenous community organizations like the Portland All Nations Canoe Family and Confluence Project to request permission to grow native Hawaiian plants on local land. The ceremony and the planting took place in August of 2021. After chanting and prayers, NHPI youth from the club tossed in handfuls of rich, black soil and planted dozens of baby kalo, already sporting several tender, heart-shaped leaves. The elders in the community watered the bed. Especially for those who had left the island many decades earlier, it was monumental to see kalo being planted in Oregon. In the first season, KALO HCC harvested 25 pounds of kalo leaves, called lau, which are used for food, medicinal purposes, and ceremonies. For her role in procuring the land, Ching was given the first harvest to make lau lau—a traditional Hawaiian dish of fatty pork or butterfish along with vegetables, all wrapped in kalo leaves and steamed. The kalo leaf softens in the process, adding an earthy flavor. The leaves are also an ingredient in other dishes like squid lūʻau. The roots, technically called corms, were left to keep growing beneath the soil; they are used to make poi, a nutritious mash that has been a dietary staple for centuries. "I haven't made lau lau since I left home, because [lau is] really hard to find here," Ching said. "When you think about how more of us now live on the big continent than in Hawaiʻi, if we move and we don't take some of that 'ike—that knowledge—with us, or find a way to grow [it], we're going to lose it." Due to the garden's success, Oregon Food Bank allotted an additional 75-square-foot space to plant the following year. KALO HCC harvested 500 pounds of leaves, most of which were distributed to community members for free. They were also able to hire one paid staff member to help take care of the māla, thanks to a partnership with Pacific Climate Warriors, an international youth-led grassroots network led by Pacific Islanders to address climate change. Now the garden produces other crops, too, including carrots, mānoa lettuce (a variety developed in Hawaiʻi), bok choy, and kale, all of which are eventually given to community members. The garden holds weekly work parties, and some 160 volunteers from diverse backgrounds help out over the course of the year, raking mulch, weeding, fertilizing, and harvesting. One volunteer drives monthly from her home in Olympia, Washington, nearly two hours away. "It's worth every mile," said Nicole Lee Kamakahiolani Ellison, who also serves on the board of KALO HCC. Ellison left the islands when she was 8 and grew up in Las Vegas. She is a project manager with IREACH at Washington State University, a research institute that promotes health and healthcare equity within Indigenous and rural populations. Ellison got involved with the garden a year ago while working on a project with Ka'ula about Native heart health. She said she didn't believe kalo could be grown in Oregon's climate. "You go down [to the garden] and you're not in Portland anymore," Ellison said. "It's like you're somehow transported back home on some weird magic carpet ride." She added that a bonus of volunteering is connecting with the kūpuna (elders) who also volunteer, as well as hearing the sound of pidgin, Hawai'i Creole. On the islands, kalo, a canoe crop—one of the plants carried to Hawai'i by the first Polynesian voyagers—is grown in both dryland (or upland) and wetland environments, the legacy of sophisticated traditional irrigation systems that ran from the mountains to the sea in land divisions called ahupua'a. (Those traditional systems for kalo, once central to Hawaiʻi's agriculture, were displaced by private land ownership, the sugar industry, and the overthrow of the Hawaiian kingdom.) Wetland taro is routinely flooded; dryland kalo doesn't require that, but needs regular rain and humidity. Optimal temperatures for kalo are in the 70 F to 90 F range. Planting in the Portland dryland garden typically starts in the spring, with the kalo leaves and corm maturing in about nine months. The garden uses primarily an Asian strain of kalo, but also includes descendants of cuttings from Oʻahu, Mauʻi, and Hawai'i Island. The kalo in the Oregon dryland garden is adapting well to its new location and growing strong. Kaʻula said the club members have learned they can grow garlic to keep the soil warm, which accelerates the kalo's growth in the spring. They also leave the kalo corm, the starchy root of the plant, in the ground during the winter, where it multiplies. One root can quickly turn into 10, she said. For now, the group is electing not to harvest the corms so that they continue to grow. This winter, they put a dome over the kalo plants to see if they would last through the freeze—which they did. Now the KALO HCC can have kalo year-round, just like in Hawaii. The success of the māla comes at a time when it may be needed most. Recent data shows that nearly 60 percent of the NHPI in Oregon lives below the poverty line. The food bank has taken hits from the recent federal funding cuts, losing 30 truckloads of food due to the Department of Agriculture's food-delivery cancellations across the U.S., and said they have already seen a 31 percent increase in visits to their locations compared with the previous year. "Our [cultural] diets are healthy, but food is expensive, and when it's expensive, many move away from that diet to something more affordable—and a lot of that affordable food is not healthy for us," Ching said. In October 2023, KALO HCC published an academic paper about their Portland kalo project, describing how establishing the māla in the continental U.S. connected people to the land, improved their mental health, and created a sense of place for Native Hawaiian community members. The paper also suggests that the garden, through cultural foods and practices, might improve health outcomes overall. "Culture is health, is what we're trying to argue," Kaʻula said. "Sometimes people say that traditional healthcare aligns with the Western models, but we're trying to say no, we want indigenous healthcare. Can we get the FDA to approve poi as medical support? Can we get the FDA to approve kalo as a supplement, and how can we ensure better access to all of that?" KALO HCC is currently conducting another study, this time through clinical trials, in hopes of finding the connection between traditional foods, physical health, and emotional well-being. For this study, they are working with Oregon Food Bank and Oregon's Pacific University to collect and analyze data. Native Hawaiians and other Pacific Islanders living in the U.S. have some of the highest rates of heart disease, hypertension, asthma, cancer, obesity, and diabetes in comparison with all other ethnicities. Research ties these poor health outcomes to colonization and historic inequities, multigenerational trauma, and discrimination, as well as poverty, lack of housing, education, and environment. "[From] what we see in other Native communities, their views of food and how it relates to health is huge," said Sheri Daniels, the CEO of Papa Ola Lōkahi, a Native Hawaiian health organization that advocates for the well-being of Native Hawaiians through policy, research, and community initiatives. Daniels said that providing data can be challenging, but offering resources and opportunities for people to improve self-esteem and strengthen cultural identity are always possible, and can yield insights, too. "The cool thing about kalo is that you get to build community, you get to meet and see others who might be in the same [emotional] space as you, trying to establish that bond of what it means to be Hawaiian," she added. As of this March, new kalo plants had already started sprouting through the soil. They will triple in size in a month, providing more nourishment to the local community in the upcoming year. KALO HCC has also created additional māla at Pacific University, where 25 percent of the student body is Native Hawaiian, and at schools in Tacoma, Washington, and within the Beaverton School District. "Everything that our lāhui (community), our aliʻi (royalty), and our kūpuna (elders) did was never about one person," Kaʻula said. "It was about, how does it trickle down? How does it create a unified community?" Co-published by Economic Hardship Reporting Project and Civil Eats. This story was produced by Economic Hardship Reporting Project and Civil Eats, and reviewed and distributed by Stacker.
Yahoo
06-05-2025
- Health
- Yahoo
Higher ed's dubious deal with prison health care
Higher ed's dubious deal with prison health care By January 2018, Tremayne Durham had been in New Jersey State Prison in Trenton for nearly a decade. Being locked up corrodes a person's health, and Durham was no exception. He was diagnosed with lumbar stenosis—a narrowing of the spinal canal—and received steroid injections. His doctor prescribed him a walking cane in November 2019. When COVID hit in March 2020, Durham was quarantined but allegedly told he couldn't bring his cane. Soon after, he says he told a nurse he was suffering horrible back pain, needed his cane, and wanted to see a doctor. When a nurse dismissed his appeal, Durham lobbied a prison guard, who said he complained too much. Over the next 10 days, Durham repeatedly asked for what he needed. Finally, he experienced what he called "severe shooting pain" while showering. Without his cane, a shower chair, or handrails, he says he fell to the floor. Officials took him in a wheelchair to the prison clinic, where he was treated for several days, Economic Hardship Reporting Project and The Chronicle of Higher Education report. In March 2021, Durham filed suit against the prison guards and nurses. The latter group is overseen by a company called University Correctional Health Care (UCHC), which provides health care for all New Jersey prisons. A District Court initially dismissed the complaint. But upon appeal, in September 2023, a judge writing on behalf of a three-person panel ruled that the lawsuit could proceed. According to the ruling, Durham sufficiently argued that prison officials showed "deliberate indifference" to his health and that he had a diagnosed disability. "It is not hard to imagine how dangerous a shower could be for someone suffering from back pain and an inability to walk or stand on their own," the judge wrote. Durham's case was sent back to the lower court. Durham was not alone. UCHC and its staff have been named in numerous lawsuits, with adult and juvenile inmates and detainees alleging neglect, abuse, and maltreatment. In 2016, the former medical director at Northern State Prison in Newark, New Jersey, was fired and had his medical license suspended for five years after he failed to do even basic testing for an inmate suffering from fainting, disorientation, and muscle weakness. The inmate died shortly after. In 2019, a detainee at a facility for sex offenders in Central New Jersey was allegedly ignored by medical personnel after prison guards assaulted him and left him for dead. (One guard was indicted for official misconduct, and a lawsuit filed by the detainee's family is pending.) In 2023, the family of an inmate who allegedly died because the effects of his post-brain-surgery steroids were not monitored filed a suit that likewise remains pending. UCHC is a nonprofit operated by Rutgers University. Instead of providing care directly or through a private provider, New Jersey grants UCHC responsibility for providing medical, mental-health, and dental care to roughly 20,500 adults and juveniles in New Jersey's jails and juvenile facilities and on parole. According to the current contract, which began in 2019 and has been extended every year through the end of 2024, the state paid UCHC almost $170 million annually for its services. The organization, which now has about 1,100 staff and faculty members, was formed in 2005. It is headed by a psychologist, Frank A. Ghinassi, but other top administrators come from backgrounds in private health care delivery, such as the chief operating officer, J. Chad Knight, formerly the CEO of a network of Atlanta physicians. Universities form health care organizations for prisons Rutgers is among several universities that have formed separate organizations to provide health care to inmates and detainees. Commonly called "academic-correctional health partnerships," the modern form of these arrangements originated in the 1990s in Texas. But they have since expanded to New Jersey, Georgia, and Connecticut, among other states. Most programs are small, but in some cases, like at Rutgers, universities have taken over health care delivery for the correctional departments of entire states, replacing the work normally done by government agencies. Indeed, after government agencies, academic medical centers are now the most common source of health care for incarcerated people in the country, surpassing private providers. Contracts between these organizations and state and federal correctional agencies can be worth hundreds of millions of dollars and affect tens of thousands of inmates. Advocates for academic-correctional health partnerships say they offer prisoners the expertise of scholars and university-affiliated doctors, provide training opportunities to medical students, and save money. "UCHC has made performance improvement a key ingredient of its health care service-delivery model," Ghinassi said when accepting the 2019 award for "Program of the Year" from the National Commission on Correctional Health Care, a trade association. Arthur Brewer, UCHC's medical director, told a Rutgers alumni magazine that the organization is a model, improving outcomes and decreasing hospitalization and mortality. "A great deal of oversight ensures that no one's care is overlooked," the magazine reported. A spokesperson for Rutgers told The Chronicle in an email that UCHC "serves New Jersey by ensuring individuals in the correctional system receive the medical care they deserve." Is that true? There is little evidence that academic-correctional health partnerships improve health outcomes for inmates and detainees, let alone that they grant prisoners the care they deserve. In some cases, the programs have been canceled after proving to be as bad as or worse than the systems they replaced. "There is not a lot of measurement of quality that goes on in these systems," says Warren Ferguson, professor emeritus at the University of Massachusetts Chan Medical School. Asked if academic institutions are better at delivering health care to inmates than other providers, Ferguson says, "The answer is, nobody knows." And this despite the huge sums that are injected into these programs. Marc Stern, a professor at the University of Washington School of Public Health, says that while the schools promise they provide top-notch services for inmates, there isn't much support for these statements: "No one's ever really studied it." In 1976, the Supreme Court ruled that inmates in U.S. prisons were entitled to adequate health care, the absence of which would count as "cruel and unusual punishment," prohibited by the Constitution. In the following two decades, the prison population exploded, ballooning health care costs for municipalities, states, and the federal government. In 1993, the Texas Legislature took a novel approach by establishing the Correctional Managed Health Care Committee (CMHCC), a partnership between the state's department of criminal justice and its public medical schools and hospitals that provides health care to inmates. The University of Texas Medical Branch (UTMB) manages care for nearly 80 percent of the state's roughly 150,000 inmates, with Texas Tech University handling the rest. The UTMB-Texas Department of Criminal Justice Hospital is an eight-story building within the constellation of buildings on the UTMB campus in Galveston, Texas. It is, according to its website, "the first and only hospital specializing in offender care on the campus of a major medical center and teaching institution," with 172 inpatient beds, an operating and recovery room, and a multiservice ambulatory-care center, all secured by locked gates. Although many Texas prisons have their own infirmaries, inmates from across the state are routinely sent to the prison hospital for surgeries and other complex services. Through CMHCC, the state paid UTMB around $630 million for its services in fiscal year 2024 and $646 million in 2025. For decades, UTMB officials have touted Texas' system as a model for other states. "Significant improvements in the provision of medical and psychiatric care to Texas' prison population have occurred during the nine years that the managed-care program has been operational," two UTMB officials reported in a 2004 issue of the Journal of the American Medical Association. In particular, they wrote, vacancy rates for medical staff declined, compliance levels with performance standards increased, and, most importantly, there were decreases in patients' rates of diabetes, cholesterol, hypertension, and AIDS. More recently, the school bragged that it has plans "to be the recognized world leader in the delivery of correctional health care services." Some programs have been canceled after proving to be as bad as or worse than the systems they replaced Critics find these purported advances unimpressive. "If you start with a dysfunctional health care system, almost any intervention, especially a thoughtful one, is going to result in improvements," says Stern, who formerly worked as the assistant secretary for health care in Washington's corrections department. Small improvements in just a few areas, starting from a very low level, do not justify the claims made by UTMB, he says. The advances they cited could have occurred by chance, even without UTMB's involvement, simply because conditions couldn't get much worse. Nor are Texas prisons improving over time; the mortality rates in 2017, 2018, and 2019 were higher than in any year prior, going back to 2001. In 2018, a Houston Chronicle report found that UTMB and the state corrections department were giving toothless prisoners pureed food instead of dentures. "There's this misunderstanding that dentures are the only way to be able to process food," Owen Murray, UTMB's vice president of offender services, told the Houston Chronicle. In fact, he insisted, "our ability to provide that mechanically blended diet is actually a better solution than the mastication and chewing process." "Generally speaking, someone with no teeth should be offered dentures," Jay Shulman, a Texas A&M adjunct dentistry professor who has testified in lawsuits over prison dental issues, said at the time. "The community standard for dental care has not been applied to prisons." Following the newspaper's report, prisoners were provided with dentures. Lawmakers have repeatedly criticized UTMB's use of public funds. In 2011, a state audit of UTMB's correctional health care found that the school was paying its doctors higher-than-standard reimbursement rates, double- and even triple-charging for some expenses, and charging the state for prohibited expenditures. (UTMB disputed some of these charges and claimed the program operated at a loss.) A 2020 state audit noted some improvement in these areas, but the same problems were still evident. For instance, "from Sept. 1, 2017, through Feb. 29, 2020, UTMB charged the program $18.2 million for UTMB employees' salaries and benefits" without appropriate documentation. The school continued using the program to pay for staff members' employee-referral bonuses and even conference-registration fees. Partly because of budgetary pressures, UTMB helped pioneer telemedicine, allowing health professionals to treat inmates remotely instead of requiring cumbersome in-person visits. Texas prisons recorded 40,000 telemedicine visits in 2010–2011 and 140,000 in 2019, saving the state between $200 and $1,000 on each. Indeed, the Texas system is now the largest telehealth network in the world. In 2010, the former head of UTMB Correctional Managed Care argued that "just about every routine exam" could be performed remotely. Interviews with UTMB inmates and their advocates suggest that telemedicine can have significant drawbacks. "Telehealth is really ineffective for what these people deal with," says Brittany Robertson, founder of Texas Prison Reform, a nonprofit that works to end solitary confinement in the state. While virtual appointments might be appropriate for bug bites or sinus infections, they are dangerously ill-suited to detecting when patients have cancer or diabetes, she says. "They swear by it, and it probably is cost-effective," then-State Sen. John Whitmire, currently the mayor of Houston, said in 2019. "But I ain't so damn sure. It's not the way I'd want my family treated." UTMB expressed pride in its unique ability to meet the challenges of COVID; officials attributed their success in part to their telemedicine program. Murray, the UTMB executive, told a reporter during the pandemic: "We've done a very good job managing those patients' care within the prison system. … We really have done a very good job with our testing and access to testing and ability to—within these prisons—quarantine and restrict movement, quarantine patients who are certainly positive for the virus but also quarantine those that have come in contact." In fact, during COVID, Texas prisons saw a 74% mortality increase, with 253 additional deaths over the previous year's total. A report from the University of Texas at Austin found that from April to August 2020, Texas had more inmates and staff who died from COVID than any other state. This might seem commensurate with its high prison population, but even proportionately, Texas prisons had some of the highest death rates in the country. In May 2020, Murray said that "the mitigation-effort steps the department has taken has been exceedingly helpful." That very month, 46 people died of COVID in Texas prisons. The Albert C. Wagner Youth Correctional Facility was a detention center in South Jersey that held 600 people until it closed in 2019. Nikeelan Semmon served four years in the U.S. Navy and two years in the Army Reserves before becoming a prison guard there. In 2016, at age 36, he was a senior corrections officer, married with a young son, and a member of Jesus My Light Holy Temple. On July 1 of that year, Semmon had chest pains and difficulty breathing. He went to the nurse's station for assistance. The nurse on duty, overseen by UCHC, told Semmon that his symptoms weren't severe enough to keep him from working, according to a lawsuit his family filed. A few hours later, he returned to the nurse's station. This time, a prison guard took him seriously and called an emergency code. According to the lawsuit, the guards who arrived to help said the nurse in charge failed to call 911 immediately, declined additional medical help, and needed to be told to get the proper equipment. The guards performed CPR on Semmon and paramedics rushed him to a nearby hospital. But it was too late—he died of a heart attack. Hundreds of prison guards lined a New Jersey street as Semmon's body was taken to and from a memorial service. Nearly one year later, Semmon's widow and son attended a candlelight vigil for him held at the Capitol Mall in Washington, D.C. His name was added to the National Law Enforcement Officers Memorial wall for those who died in the line of duty. Lawyers working on behalf of Semmon's family alleged that if he had received timely and appropriate medical treatment and had been transferred to a hospital earlier, he would not have died. In 2021, UCHC paid his family $1.5 million in a settlement. Overall health of individuals in New Jersey prisons remains poor Like UTMB executives, UCHC officials have long portrayed New Jersey as a model for how it handles the health of inmates. "In a civilized society, prisoners should get adequate care; it's the right thing to do," Jeffrey L. Dickert, then-UCHC's chief operating officer, said in 2016. (He has since retired.) In a 2014 paper in the Journal of Correctional Health Care, five experts at UCHC and Rutgers concluded that the state's prison system, as well as its patients, benefited from the partnership. "UCHC is currently providing a level of mental-health and medical services to inmates in the prison system that is achieving better outcomes than what is typically found in the community," they wrote. As proof, they cited evidence that inmates in New Jersey prisons had lower hypertension rates than Medicare and Medicaid patients and that a higher percentage of inmates received diabetic care in New Jersey than in Michigan. In addition, about 80 percent fewer inmates had been transferred to the state's forensic psychiatric hospital since UCHC took over mental health for the prisons, without an increase in suicides. "Most [inmates] return to society after three to five years," said Donald Reeves, UCHC's director of psychiatry. "It's our goal to return them in better shape than when they arrived." The overall health of individuals in New Jersey prisons remains poor, however, even accounting for any progress introduced by UCHC. Data compiled by the state and obtained through public-records requests show that the average age of death of individuals in state prisons (except a facility that holds sex offenders following their sentence completion) has ranged between 52.2 and 60.7 since 2009. This is well below the state's average life expectancy of 77.7 years in 2020. Similarly, a 2024 report in The Guardian found that men in New Jersey's prisons died, on average, more than 12 years earlier than the overall population, often after receiving little care while they were ill. Black men died an average of 14 years earlier than all men in the overall population and seven years earlier than Black men in the overall population. Some prisoners died of treatable cancers, while others died from treatable symptoms of chronic diseases. "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 health care in state prisons," according to the report. In 2016, Brewer, UCHC's medical director, said inmates have easier access to health care than the public. But during COVID, New Jersey prisons were some of the deadliest places to be incarcerated in the United States. A study from the University of California at Los Angeles found that 47 more deaths occurred in the state's prison system in 2020 than in 2019, a staggering 142 percent mortality increase—even though the prison population decreased that year, as inmates deemed to be low-risk offenders or especially vulnerable were released. This was far worse than the overall national increase of 62 percent. A facility in Central Jersey that detains sex offenders indefinitely after their criminal convictions, and where UCHC oversees health care, had the single highest COVID mortality rate of any institution in the United States. Under the terms of the state contract, UCHC must provide the Department of Corrections with a range of monthly and annual reports measuring things like the mental health of inmates, litigation, grievances filed, incident reviews, compensation and benefit plans, and much else. But the corrections department told The Chronicle that it possessed only a few reports from just three months in the spring of 2024. A UCHC spokesperson referred The Chronicle back to the DOC. In addition, under the contract terms, the DOC is required to compile reports assessing UCHC's performance. It couldn't find those reports, either. UCHC insists that it delivers high-quality care to inmates—and that doing so is cost-effective. The program "makes economic sense for New Jersey," Dickert said in 2016. "Inmates can sue if health care is withheld, and this litigation is costly. Those who are denied care may require hospitalization. This costs taxpayers even more money." But an audit of the state prison's medical contracts found that, between the summer of 2013 and the summer of 2015, UCHC charged medical providers $905,300 in claims for inmate hospitalization expenses that it never incurred, was reimbursed for employee salaries at improperly high rates, and had staff members inaccurately logging the hours they worked. The audit, which noted that many other UCHC procedures were adequate, was conducted by the state legislature and obtained through a public-records request. More generally, health care costs for inmates in the state have continued to skyrocket. Indeed, they have been the driving cost of the continued increase in New Jersey's prison budget, which has risen steadily—it saw a 12 percent increase over 2023 alone—even though the inmate population is down 30 percent since 2020 and the state has shuttered four prisons. A 2023 report from the state Department of Corrections Ombudsman found that the second-most common complaint inmates had, after concerns about their property, was related to health care. According to the report, "A significant number of incarcerated people and their families contacted the Ombudsperson Office about pending requests to be seen by health care providers, accessing follow-up information about test results and labs, wait times for specialist appointments, and medication refills." Trainees commented on the shockingly advanced pathology of the inmate patients. Meanwhile, Ghinassi, UCHC's president and CEO (who also heads Rutgers's mental-health care system), drew a salary of $792,467 in 2023; Arthur Brewer, the medical director, earned $361,683. Conversely, as of June 2024, the Department of Corrections refused to spend the $2.6 million that state lawmakers allocated more than a year ago to give inmates their first wage increases in more than 20 years. Some inmates make $1 per day at their prison jobs, and the highest wage is less than $8 per day. Until the policy was suspended in 2020, the state required that inmates pay for any medical care they incurred while locked up. Inmates are still charged a fee if they take prescribed medicines. Nearly all UTMB's medical students and residents complete a rotation in the prison hospital. Academic-correctional health partnerships frequently tout the experience that idealistic young people obtain in working with a deeply vulnerable population as a major benefit of the initiative. "The physician-assistant students who train at [the prison hospital] often comment that it has been their best rotation, because they are able to learn so much from just one patient," according to UTMB Health, the school's newsletter. A doctor explained in the newsletter that inmates have rare conditions, offering unique learning opportunities for students. But some students approached Jason Glenn, an assistant professor who was then at UTMB and who studies incarceration and health care (now at the University of Kansas), to say their experiences had made them uncomfortable. Over three months, beginning in December 2014, Glenn and his colleagues conducted focus groups with UTMB medical trainees. The results, first published in 2020 in the journal Health & Justice, were dismaying. Instead of expressing a unique empathy, the medical trainees mimicked a widespread suspicion that administrators and senior staff members taught them: Inmates were usually feigning illness. This suspicion remained even after inmates were properly treated, proving they had needed care. Even as trainees were conditioned to think inmates were quick to feign illness, each of Glenn's focus groups still commented on the shockingly advanced pathology of the inmate patients. "There are a lot of interesting diseases and things you don't get to see in a developed country," one trainee explained. Advanced cancers were particularly common, as was the risk of tuberculosis. Alarmingly, respondents said they were given more responsibility to treat and help operate on patients than they would have been if the patients weren't prisoners. "When I was in surgery … I was first assist on at least half the cases that I scrubbed into," one student confided. UTMB students routinely indulged their curiosity by searching for their patients' criminal histories, often easily available online. There were no institutional guidelines around such behavior. Invariably, some trainees let their negative moral judgments of the patients influence their work. "If I know what they did and it's something that I felt strongly about," one student admitted, "I may not even do it on purpose, but I may not do the hardest that I can. I may not do my best." The elusive search for best practices Glenn and his colleagues put together a list of all the universities that partner in one way or another with prisons. Alongside the direct providers like UCHC and UTMB are more common, smaller collaborations that exist across the country, from New Mexico to Washington and from Florida to New York. Individual faculty members sometimes volunteer or work at jails and prisons. In other cases, initiatives primarily train students and residents as part of a course in underserved populations, as part of a community-residence rotation, or as part of a fellowship, while other trainings are devoted entirely to correctional health. For instance, George Washington University's School of Medicine and Health Sciences offers an elective course titled "Introduction to Correctional Medicine," in which students work in local jails for four weeks. They also have a volunteer program for students to help deliver health education to detainees. George Washington offers some of the country's first academic programs in correctional-health administration: an online graduate certificate and a master's degree. Glenn's team reached out to each program to inquire about their standards. Although they had been around for decades, Glenn wanted to know if there were common procedures or best practices. "What we found is they're all just kind of winging it," he said. In compiling the list of academic-health partnerships, Glenn found that nearly 35 initiatives of varying sizes existed at one time or another—but that some had been canceled. Soon after UTMB's program was established, the University of Connecticut partnered with the state's Department of Corrections to establish Correctional Managed Health Care (CMHC), which provided all medical, mental-health, pharmacy, and dental care for inmates. The arrangement continued for more than two decades. In 2017, the contract was worth $82.7 million. In its annual report that year, CMHC pledged to become "a national leader in correctional health care." Alas, 2017 would be the last year CMHC existed. State auditors had long noted that the CMHC's negligence in keeping adequate records led to major failures. For instance, three prisoners with foot troubles—a loss of sensation, amputated toes, a worn-out prosthetic foot—were reportedly denied care. But it was impossible to determine if they received proper care because officials didn't keep proper records. The state paid $1.3 million to an inmate after he claimed CMHC staff delayed identifying and properly treating his skin cancer by more than a year. "They don't treat us like human beings," the man said. Finally, in 2018, Connecticut ended the partnership and returned responsibility for health care to the corrections department after a consultant's report found CMHC's system provided "untimely" health care and lawsuits kept piling up. In the second decade of CMHC's work with the state, the attorney general fielded more than 1,000 complaints and lawsuits from inmates about the shoddy health care and medical conditions in its jails. The University of Connecticut denied providing substandard care. But when the state contract ended, so did CMHC. The University of Connecticut was not alone in failing to realize its ambitions to be a leader in correctional health care. In 2016, the sheriff's office in Fulton County, Georgia, awarded a nearly $20-million contract for prison health care to a Tennessee-based private company called Correct Care, which subcontracted with Morehouse College's medical school. But beginning in August 2017, five inmates died within a 75-day period in the jail, The Atlanta Journal-Constitution reported. First, three people recovering from opioid addiction killed themselves in short succession. Authorities said medical-intake officials should have been prepared for the inmates to have psychiatric struggles and potentially be a danger to themselves. Soon after, a woman who was in jail for violating probation on a drug conviction complained of pain and trouble breathing. She was later found lying on the floor, naked, unresponsive to a nurse's question—but the nurse walked out and said there were no medical concerns beyond mental-health problems. Within minutes, the woman was dead. Finally, days later, a diabetic man with exceptionally high glucose levels died after Morehouse officials failed to give him his prescribed insulin. As a result of the spate of deaths, Fulton County declined to renew the contract. "Morehouse is not qualified to do any of this," Fulton's chief jailer said, according to the Journal-Constitution. Some universities have found novel ways to cash in on prison health care. In 1998, the University of Massachusetts Chan Medical School began providing mental-health services to the state Department of Corrections. "Movement into correctional health care makes fiscal sense for medical schools," two UMass staff members explained in a 2002 paper in Psychiatric Services, co-written with a corrections staff member. "The medical school benefits by building its revenue base." Making good on this promise, UMass has pioneered a different model—it operates a consulting division, now called ForHealth Consulting, with more than 400 contracts and 1,100 employees in more than 25 states. Since 1999, ForHealth has been working with the Bureau of Prisons (BOP), and one of its projects, since 2012, is acting as a third-party administrator managing comprehensive medical services for about 5,500 inmates at a federal prison in Butner, North Carolina. In September 2023, an NPR investigation found that 1 in 4 inmates who die in the country's 120-plus federal prisons do so at Butner. Because the prison has a hospital and the largest cancer-treatment facility in the country, terminally ill inmates are routinely routed there. But the high mortality rate might not be only a matter of size. A 2022 Justice Department audit of UMass's contracts with Butner and prisons in Massachusetts and New York—totaling more than $300 million—found that the BOP personnel there "did not have a reliable, consistent process in place to evaluate timeliness or quality of inmate health care." In addition, the BOP kept shoddy records at UMass prisons, bought equipment without open competitions, and went beyond its authority in approving invoices. "We believe it is difficult for the BOP to determine whether inmates are receiving care within the required community standard," the report added. As a for-profit company, ForHealth isn't required to disclose its clients or financial records, despite being closely associated with a public university. In an email, a spokesperson told The Chronicle: "Our history, background, and milestones as part of UMass Chan Medical School are available via our website. Our clients and partners include health care and human-service organizations in states across the country and our annual revenue contributes to UMass Chan's mission." A few years ago, Glenn and several other academic health experts nationwide decided they had seen enough. They were particularly disturbed by reports of shackling incarcerated women while they gave birth. No laws mandate such a thing, but prisons and jails have significant leeway to tell medical personnel that it's done for safety reasons, usually with little pushback. Similarly, prisons and jails often prohibit academic medical centers from contacting the family members of inmates facing important medical situations. Glenn and others started drafting a Patients' Bill of Rights that outlines to prisoners the minimum care they are entitled to receive and explains to academic medical centers the laws in different states and their obligations to the inmates under their care. "All the ethical obligations that medical providers have to patients do not cease just because those patients are under the jurisdiction of any given state's department of corrections," Glenn says. The bill is meant to be an open-source resource that details academic institutions' authority when dealing with correctional institutions—an authority they don't always understand. Glenn presented a paper on the bill at the 2023 conference of the Academic Consortium on Criminal Justice Health in Raleigh, North Carolina, and the document is currently being finalized. Some of the experts interviewed for this story caution that, even though the model is unproven or flawed, academic-correctional health partnerships have the potential to improve the woeful state of American prison health care. "Many academic health-science centers consider their role as not just providing high-quality care for people who have means, but to also ensure that there is health equity in providing health care and quality health care to all populations who are at risk. And that's inclusive of people who are incarcerated or people who are involved in the legal system," says Ferguson, of UMass's Chan Medical School. He says that while universities generate revenue from partnering with prisons, the programs are also costly and require a lot of infrastructure development. Newton Kendig, a clinical professor of medicine at George Washington University, says that academic centers can offer benefits, providing incarcerated patients access to telehealth subspecialty care services that are not otherwise available in many rural settings. At this point, however, scant research supports the notion that these programs can significantly improve upon state-run correctional agencies. The experiences of the systems in Texas, New Jersey, and Connecticut do not bolster claims by universities that they are able to provide high-quality care to inmates. Indeed, they raise questions about whether universities can change the status quo at all—or whether they merely become complicit in a negligent system. As Dickert, UCHC's former chief operating officer, has said, "We're guests in the DOC's house, and we conduct ourselves accordingly." Co-published by Economic Hardship Reporting Project and The Chronicle of Higher Education. This story was produced by Economic Hardship Reporting Project and The Chronicle of Higher Education and reviewed and distributed by Stacker.
