Disabled in Prison: Daniel's journey.

Some folks think that criminals who are abused - or even murdered - in prison probably got what they had coming - as if some kind of Divine Justice is meted out when the "worst of the worst" brutalizes eachother where our laws otherwise prohibit it. Most of the folks I see being victimized in prison, though, aren't the kind of criminals we all love to hate. The ones being victimized so often are vulnerable to exploitation, violence, neglect and abuse due to a serious mental illness, closed head injury, or developmental disability - not because their crime was so heinous that the other prisoners felt compelled to punish them, too. The Divine hand I put my faith in would intervene to stop the neglect of and violence against these prisoners - not silently condone it. That is the hand that causes me to write this post today. I hope that same hand compels others to respond.

Cognitive impairments, disabilities affecting communication, and laws designed to prevent prisoners from filing "frivolous" lawsuits against their keepers - like the Clinton-era Prison Litigation Reform Act (PLRA) - make it extremely difficult for some individuals to assert their rights behind bars. I received the following letter from one such prisoner nearly two years ago, when I didn't really know what I was doing, and I wasn't much help to him. It was somewhat outdated then, and getting updates from Daniel has been hard, I presume because he depends on the kindness of others to help him write. The last letter I sent him was July 23; I haven't heard back yet. As I understand it, though, not much has changed for him.

According to his record, on November 2, 2001, Daniel killed three people. I don't know how; I always presumed it was in the accident in which he was so badly injured himself, since the convictions were for manslaughter. That's a lot of devastation to cause in one fell swoop - and a lot to live with, for both the survivors and the one who destroyed those lives. 

Daniel was sentenced to three consecutive ten year terms in state prison for his crimes. He has lost his freedom, been exiled from society, and grown estranged from his family as a consequence of his actions. Short of death, incarceration and lifetime felonization are the most severe penalties we can hand out to people; incarceration is in itself a special kind of torture. Prisoners of war and kidnap victims are treated for PTSD even if they were well cared for by their captors, because simply being involuntarily seized and imprisoned causes terror and trauma. We don't need to add individualized torment and humiliation on top of what we have already decided to dish out to those we have imprisoned. That is cruel and unusual, and barred by the US Constitution for a reason. It's not just becuase of what it does to them when prisoners are neglected or abused- it's because of what it does to us, too. Our own humanity is diminished in the process of doing so to another.

When I received Daniel's letter I spent my energy trying to get help from the organizations that I thought were supposed to intervene in cases like his, to no avail. What I learned in my quest was that the DOJ answers almost every SOS from prisons with a form letter denying any intent to investigate, and the resources of the American Civil Liberties Union are quite limited. The Arizona Center for Disability Law - which is the only Protection and Advocacy agency in the state for people with  disabilities refused at the time to serve disabled individuals in custody, simply because they were in prison. As far as I know, except for lending technical assistance and the weight of their P&A authority to the  Parsons v Ryan litigation, they still don't serve disabled prisoners. I called a few attorneys at the time but found no takers; Daniel, of course, can't afford to retain one, so they'd need to be willing to take his case on pro bono.

The ACLU-AZ and ACDL now have their hands full in with Parsons v Ryan, the class action suit they're pursuing against the AZ Department of Corrections for substandard health care. Hopefully that will ultimately help prisoners like Daniel. But any settlement or judgement that comes out of it - if there is one - will be years down the road - he's suffering now, and the degree to which he can regain any functioning through physical therapy declines with time. 

The matter of accommodating people with disabilities for moral and legal reasons aside, someday this man will be free again, and totally dependent on public benefits if we can't help him engage in rehabilitative activity and learn to compensate for his disabilities soon. Daniel was 19 when this tragedy happened that landed him in prison; he will only be 47 when he is released, according to his earliest supervised release date. He can still be productive and contribute to his community once free - unless we leave him to waste away in prison as he has been, growing more dependent and more bitter with the passing of the years.

I believe the conditions of confinement that Daniel has endured, as well as the neglect of his requests for reasonable accommodations, are an egregious violation of the Americans' with Disabilities Act, and he has suffered both physical and psychological harm that was not intended by his sentencing judge as a result. If there are any attorneys or disability rights advocates reading this now who think they may be in  a position to help this man, please contact me, Peggy Plews, at 480-580-6807 or arizonaprisonwatch@gmail.com.

Daniel's Journey

ASPC-Tucson

January 2010

I was shot in the back twice with a 357 magnum.  I lost 1 kidney, 3 feet of intestine, piercing my liver and stomach as well.  I went out the back window of a vehicle at over 90 mph, split my head open & was in a coma for over 6 weeks.  I suffered severe brain & nerve trauma, as well as collapsed a lung, needed a trayek, stomach tube to be fed, tore every ligament in left leg, shattered my right femor, which was replaced.  Destroyed 2 bones in left arm, got replaced, destroyed all 3 major nerves & all tendons in left arm as well.  I also had a catheter, which was never supposed to be taken out because of the severe brain damage I acquired, & I urinated on myself for well over 9 months, at least 100 times a day, & frequently still do.  Never was I supposed to walk either.  So, in 2002 I came to prison, 1 year after my accident.  I fell on my face 100 times a day, crippled people fall much harder than normal people with balance, all the while urinating on myself, only able to take a shower every other day. 

I never got info, help or therapy for any of my disabilities.  I loved my family very much, needing to hear from them, so I began my sessions of pure painful frustration to regain my writing ability.  I would have to write twice a day everyday, painfully, bloody blisters is what I created just to keep the ability I acquired, which was garbage.  And, to create the garbage, I would have to press down really hard to stop my hand from shaking, creating a wound, that had to be broke open that night or I would lose the garbage ability I created.  I even developed a way of stopping the blisters from being created.  I had to buy constant bandaids, which we could only buy 1 pack of 10 a week, so I had to get other people to buy every week as well, so I didn’t lose the garbage ability I acquired, what was at least readable if you focused & were able to see thru the blood.  I was unable to tie my shoes, so that made a lot of things more difficult.  Was unable to brush teeth or any other things that needed two hands or required fine motor skills, which I just found out was one of my major disabilities, 7 years being in prison.  I was unable to communicate with my family, friends or loved ones.  I missed all of my daughter’s baby years growing up regardless, but not even being able to hear about them because I couldn’t write & correspond was torture!

Any little cold or medical problem I was automatically denied treatment for because of not even being able to fill out an HNR.  In ’03, I started to acquire small cuts on my fingers and mouth that would not heal & were very painful.  I couldn’t imagine what they were from until I just presumed they were from not drinking enough water & only having 1 kidney.  So I got someone to fill out an HNR & made it to the doctor, who confirmed my theory.  So, I drank more water, but the cuts kept appearing, so I drank more water & the cuts on my fingers & mouth kept showing up becoming more & more painful.   

So, once again I begged to have an HNR filled out the doctor said I wasn’t drinking enough water.  So, I could never get this simple, yet very painful problem taken care of.  And, I was drinking several gallons of water a day & was just dealing with crazy pain from such a simple problem.  All the while continually falling on my face pissing on myself that much more, smelling up the runs until I made it to a 4 yard.  Then it was just my cell stinking, getting my cellie made at me!  Getting in numerous fights physically with my cellies, as well non-stop arguments, being physically & verbally abused.   

That is about the time I started to see the dentist on my several years of not being able to brush my teeth properly.  My many years of painful cavities & the painful fillings they created, numerous fillings and root canals.  Now, Dec 31^st ’09, I got two painful cuts on my lip that will not heal, still I’m getting these cuts on my lips from brain trauma!  Starting in ’03 D.O.C. began to start their continual denial of treatment & cause suffering & pain from not listening to me when I said I cannot have my finger nails clipped like a normal person & they’d bleed if they were.  So, every month the nurses would clip my nails & make them bleed, despite my attempts to get them filed.  That happened until the supervisor nurse Nash at Rincon unit in ’07 paid attention to the nurses constantly making me bleed & my yelps from the pain every month, sometimes it needed to be done twice a month & she got myself the info I needed to fill out to get a pumice stone.  So, I ended up only having to have the intentional pain of having my fingers clipped by D.O.C. FOR ABOUT 4 YEARS.   

Now, it’s ‘09& I’ve been trying to get an arm brace since ’07 to stop the constant atrophy from turning my left arm into a ball.  And, it’s now Dec 31^st ’09 & my arm is curling up in a ball, killing me.  I’ve been approved from the doctor that works for D.O.C. to have a cell mate assistant since ’06 & numerous deputy wardens have refused their own physician’s prescriptions & the o DW now Jacobs.  I’ve talked to her several times & she says, “it will be taken care of when she finds the time, there’s other more important things.” & that’s why I have to go without communication with my family, friends & loved ones during the holidays, brushing my teeth, functioning without having to beg to have my shoes tied, being able to turn in HNR’s or any inmate letters.

It’s 1/1/10, & still no brace for my arm.  I can literally feel it curling as I’m writing these words.  In ’03 I started to have a severe pain in my right testicle, so I begged to have a C.O. fill out an HNR, being in SMU, I made it to the doctor who said it was just a hydrocele & I wasn’t going to die.  The next couple years it grew larger & larger, giving more & more pain, as well making it that much more difficult to rehabilitate by myself with no therapy until finally it didn’t just beat me up both physically & mentally, but making every single other thing harder to function, but broke me down physically & I collapsed in ’06.  

The nurses came took my vitals, put me on a lay in over the weekend & seen the doctor Monday, who said I’d live.  In ’08 on a Friday my testicle was the size of a baseball & forced me to the ground again & I was taken to medical again, told I was going to live, given a lay in until I see the doctor on Monday.  Sunday came around & it forced me to the ground again with unbearable pain.  I went to the hospital in an ambulance this time, where the doctor told me I definitely needed surgery, but he couldn’t perform if I was going to live unless D.O.C. approved it.  I was taken back to prison & after was told my surgery was approved.  I was told by the surgeon that there was a large percentage of the hydrocele returning after surgery if I continued my rehabilitation with no therapy.  So, with the mental stress from having a baseball for a testicle for 6 long years & the constant physical pain & from it making everything so hard to work on rehabilitation myself on my own I was manipulated by D.O.C’s negligence into having one of my testicles removed!  

 In ’09 I was told by Ms. Mongia, a 504 representative that works for D.O.C. that I was supposed to be provided physical therapy for my arm, as well for my other physical therapy needed, my writing, brushing my teeth, feeding myself, walking, running, as well for occupational therapy.  So, I turned in a HNR asking for, which was returned with the response this is not an ADA yard, where I wouldn’t get no therapy, occupational nor physical, as well would be denied my physical access & movement, which is mandatory I’ve learned for people with severe brain & nerve trauma like I possess.  Which was like when I was placed in SMU & Central unit with no movement & I kept losing my movement abilities over & over, which were beyond impossible to establish, especially without therapy, instruction or even a direction or just an opinion.

1/7/10

I received a First Level Appeal Response to answer my inmate First Level Appeal that I wrote on Oct. 21 ’09, today 1/7/09.  Stating, that it’s been noted that I’ve received treatment over the last year to accommodate my disabilities, which included the issuing of knee sleeves, an arm brace, and recent steps to replace an arm brace due to irreparable damage.  Also stating, I’ve been evaluated and diagnosed for a sore right shoulder incurred as an injury after my participation in repetitive pull-ups.  I’ve requested adjustments on my arm brace since ’07 & got documentation of continual pleas since 5/12/09, several, and have all just sent me around in circles.  I’ve gone to the HUB several times since ’07 being fitted for a new arm brace & continually apologized to by different medical personnel employed by D.O.C. for D.O.C. not sticking with a company, not allowing them to do their job by letting them come to work to do their job & still haven’t received a brace.   

The knee sleeves I was issued by my request, supposing that they would probably help me not get arthritis if my knees are constantly popping.  My arm brace finally was taken & I was seen for replacement in Nov., I still haven’t received a replacement, all the while, like it has been for the past 7 years, except in ’06 when I got an arm brace, my arm is literally killing me from pain & curling up in a ball.  I haven’t received any kind of physical or occupational therapy, which I was made aware I qualified for because of my impairments & to request for by a Ms. Mungia, a 504 personnel employed by D.O.C. in June of ’09.  I requested & my response was this is not an A.D.A. yard.  The injury in my shoulder I got was from pull ups, which were done to somehow stretch the tendons, self sufficiency therapy, since no therapy was being provided, as well a step approved by the supervisor nurse Larry, who stated my arm would be so much more crippled from all the atrophy & having no brace, no therapy if I wasn’t doing them.

The ADA and disabled prisoners: RESOURCES.

I've been receiving a considerable amount of mail from prisoners with disabilities of late, who aren't getting their medical needs taken care of, or being offered reasonable accommodations when they ask. The article below addresses how the Americans With Disabilities Act (ADA) applies to people with disabilities in prison and jail.

In Arizona the primary advocacy organization for persons with disabilities is the Arizona Center for Disability Law. The ACDL has joined the ACLU-AZ and the Prison Law office in PARSONS v RYAN, the class action lawsuit against the AZ DOC over prisoners' health care rights and the abuse of solitary confinement with mentally ill prisoners. As a rule, however, the ACDL doesn't intervene on behalf of individual prisoners with disabilities. It may not hurt to contact them if you have questions about the rights of disabled prisoners, however - if they don't know the answer, they of all people should find it out. They can be reached at: 

Arizona Center for Disability Law
5025 E. Washington Street, Suite 202
Phoenix, AZ  85034
Phone:  (602) 274-6287 (voice or TTY)
(800) 927-2260 (toll free)
Fax: (602) 274-6779

Here's the ACLU's brief handout on the legal rights of disabled prisoners. 

The Center for Public Representation out of Massachusetts has a good brief rundown on litigating ADA cases involving prisoners. 

Also of use is the guide, "PRISONER RIGHTS" published by the Disability Law Center of Alaska. State laws may vary, but the 14th Amendment guarantees equal protection under the law - the ADA is the ADA everywhere in the USA.

Here, too, is the US Department of Justice's page on the ADA. 

Asking for a reasonable accommodation in a local jail or the state prison would generally involve going through the medical department, and may require prisoenrs to file medical grievances. Under the Prison Litigation Reform Act (PLRA) they must "exhaust administrative remedies" in the course of requesting a reasonable accommodation before filing any kind of suit. 

Information on the grievance procedures for the Arizona DOC is here: Department Order 802: Inmate Grievance Procedure.

Here is a link for the Maricopa County Superior Court re: accessibility issues. I looked extensively for info on Maricopa County jail prisoners with disabilities, policies on the ADA in the jail, etc with no luck. Follow the MCSO's grievance procedure and contact me if you/your loved one in jail are running into trouble (Peggy Plews at PO Box 20494 / PHX 85036  / 480-580-6807 /  arizonaprisonwatch@gmail.com).

Defy Prison Violence:

"Assert Humanity"

AZ DOC HQ Sidewalk

August 2, 2012

-----------via the Free Library ------------

Disabled Prisoners and Reasonable Accommodations

Robert B. Greifinger

Criminal Justice Ethics, January 2006

In 1990, the United States Congress passed the Americans with Disabilities Act (1) (ADA)--an optimistic measure intended to provide equal opportunity in employment and public life to individuals living with physical and mental disabilities. Title II of the ADA guarantees disabled persons equal access to state services and programs, an assurance that the rights these programs fulfill will be protected. (2) Title III mandates "reasonable accommodation" to the needs of the disabled in public facilities. (3) The federal statute includes both a prohibition against discrimination against disabled persons and a provision for redress. Legislators recognized that without the prospect of "effective enforcement provisions," the states would be unlikely to move into compliance with the new legislation. It is now well understood that the United States population of disabled persons was significantly underestimated at the time the legislation was approved. (4) And it can be taken .for granted that the sponsors and supporters of the ADA were not thinking about the disabled among the population of those in prisons and jails, that population now more than two million. (5)

Prisoners are almost wholly dependent on the physical conditions and services of their facilities. It is this dependency--the absence of any alternative source of medical care--that gives prisoners a constitutional right to health care. (6) Thelength of a sentence will often depend on program participation while in prison; procedures for release, such as release to parole supervision, normally assess the rehabilitative efforts of a candidate. However, prisoners with mental and physical disabilities are disadvantaged. They must manage within the security-first concrete and steel priorities of correctional facilities and often must rely on the good will of other prisoners for assistance with activities of daily living, such as hygiene, nutrition, and mobility. Without the ability to use staircases, they may not be allowed to work and are thereby denied the nominal wages paid to prisoners for work. They may not be allowed to enroll in programs and prerelease training or education because of their problems with learning, mobility, or being housed in a medical or psychiatric unit. Without basic medical and psychiatric care, or necessary prosthetic or assistive devices, they face an increased risk of injury in difficult and dangerous prison environments. Prisoners, however, anticipated the promised benefits of the ADA, and pro se litigants have repeatedly brought their claims to federal courts. (7) 

Although the U.S. Supreme Court ruled in 1998 that the ADA applies in the prison context, (8) states have resisted accommodation. State legislators in a handful of states exempted disabled prisoners from protection against discrimination, (9) and states generally have argued that they have Eleventh Amendment immunity to civil rights claims for damages arising from violations of Title II of the ADA. In a recent decision, however, the United States Supreme Court has ruled that, insofar as Title II ADA claims involve conduct that violates the Fourteenth Amendment, states do not have sovereign immunity. (10) Pro se prisoner Tony Goodman, a paraplegic confined to a wheelchair, filed suit under 42 USC [section] 1983, arguing that he was confined for 23 to 24 hours a day to a cell too small to turn the wheelchair around, that he had been effectively denied access to basic sanitation, medical care, and program participation, and that he had injured himself in efforts to use the toilet. The state of Georgia had argued successfully to the Eleventh Circuit Court of Appeals that it had sovereign immunity to the monetary claims arising from the ADA. Justice Antonin Scalia, writing for a unanimous Court, observed "[N]o one doubts that [section] 5 grants Congress the power to enforce the provisions of the [Fourteenth] Amendment by creating private remedies for actual violations of those provisions'--reminding the Eleventh Circuit that the prisoner's claims were violations of the Constitution as well as the ADA. As federal courts consider the implications of this decision, three general questions are relevant: (1) What percentage of prisoners will qualify as disabled? (2) What counts as "reasonable accommodation" to the needs of physically challenged and mentally ill prisoners? and (3) Does it not make sense to consider alternatives to incarceration for many disabled prisoners, thereby reducing the potential cost of providing reasonable accommodations behind bars?

The prisoner litigants whose cases proceed in federal court are often those with the most extreme set of facts: paraplegic, incontinent, or severely disabled individuals. But the definition of a "disability" is defined in the ADA as: "(A) a physical or mental impairment that substantially limits one or more of the life activities of such individual; (B) a record of such an impairment; or (C) being regarded as having such an impairment." (11) Of the general population in the United States, the Census Bureau finds that 18%, or 51.2 million people, have a disability and 12%, or 32.5 million, have a severe disability. (12) People with severe disabilities are poorer, with a median annual income of $12,800.

Prisoners and detainees are poorer and sicker than those responding to the Census surveys. (13) Estimates of mental illness among those in prison range from 16% (14) upward to a majority--the finding of a current study released by the Bureau of Justice Statistics in September 2006. (15) These are people who are at risk either physically or mentally. They are vulnerable to substandard care because of erroneous assumptions about them. (16) It would not be unrealistic to expect that a third of prisoners would qualify for reasonable accommodation if we were to take seriously a rehabilitative purpose for imprisonment. In practice, those disabled persons are simply not chosen to participate in educational or training programs. Whether or not the prison officials engage in conscious discrimination, the impact on disabled prisoners is to limit their opportunities for employment and re-integration upon release.

Consequences of failing to make provision for those who live in prison with disabilities can be grave for the individuals concerned. Mentally ill prisoners are much more likely to earn disciplinary sanctions for breaking prison rules or failing to respond promptly to orders, and to accrue further criminal punishment that extends the length of their confinement. Although some prison administrators do recognize mental illness as a mitigating factor as they assess infractions, those prisoners whose disabilities make it hard for them to comply with prison rules often end up with long periods of isolation. Isolation can deepen and exacerbate mental illness, and can prompt acts of self-harm. (17)

For the growing fraction of life-sentenced prisoners who are now aging into their 60s and 70s in state and federal prisons, (18) and for the increasing proportion of middle-aged and elderly in the prison population, (19) the questions are: what accommodations should be considered and what are the core activities (of a life in prison) that should be protected? For the past twenty years, I have worked on medical care programs behind bars. Through this work as an executive or consultant in prisons, jails, and juvenile detention centers across the nation, I have seen each of the following accommodations successfully implemented. These are practical and achievable objectives:

* Medical care and physical plant accommodations for patients with multiple chronic medical illnesses such as chronic respiratory disease, diabetes, arthritis, and heart disease, diseases that are highly prevalent among the poor, who are over-represented in prisons and jails. (20) In addition, there are conditions whose prevalence is uniquely high behind bars, including paraplegia secondary to gunshot wounds, advanced liver disease from alcohol abuse and/or viral hepatitis C, and end-stage kidney disease from injection drug use and/ or HIV infection. Geriatric patients are at special risk for acute infections, such as influenza and pneumonia. (21)

* Mental health care and physical plant accommodations for patients with serious mental illness, such as schizophrenia, bipolar disorder, major depression, and post-traumatic stress disorder. The prevalence of each of these is higher behind bars than in the community. (22)

* Medication for patients with chronic medical problems and mental illness.

* Protection from heat injury for those especially susceptible, including those with chronic illnesses such as diabetes and those who are on medications that increase the likelihood of heat injury, for example, medications for psychosis and heart disease. (23)

* Skilled nursing care for patients with functional disabilities that interfere with their activities of daily living: bathing, dressing, eating, transferring, and toileting. Some patients with physical disabilities need mobility aids that can be hard to come by behind bars. In prison, there are activities that are unique to daily life, called "prison activities of daily living." These necessary actions include dropping to the floor for alarms, standing for head count, moving to dining areas, climbing on top bunks, and hearing orders. Rates of functional impairment are higher when these activities are measured. (24)

* Programming for patients with physical or functional disabilities, including those with chronic disease, mental illness, and developmental disabilities. Patients with vision and hearing problems are common among older people. (25) These conditions can result in falls, social isolation, depression, and functional physical disability. Patients with cognitive impairments, such as dementia, from aging or medical conditions such as HIV or viral hepatitis C are physically vulnerable.

* Training for correctional staff to recognize that failure to cooperate with prison rules can be caused by impairments of sense (hearing or vision), dementia, or mental illness. These patients are too often disciplined with segregation status instead of being referred for evaluation, treatment, and protective housing. Likewise, patients with physical disabilities that cause problems such as vomiting or incontinence too often get disciplined for soiling instead of being evaluated by medical care staff.

* Personal safety protection for those with physical or mental disabilities, especially the elderly.

The modifications that would be warranted by a scrupulous application of the ADA to prisons and jails--increasing physical access within a facility, increasing timely contacts between prisoners and social service and medical staff, increasing congregate time for education and training--run immediately up against the security provisions, some of which are policy-driven and others of which result from the design of a particular facility. As it was expressed by lawyers for the group of states arguing for sovereign immunity: (26)

Like most Americans, amici applaud the ADA's goal of ensuring that disabled citizens are protected from invidious discrimination and have every opportunity to participate fully in the benefits our society provides to other citizens. Prisons, however, are dangerous places for all who work or live there.... Recognition of private ADA claims has the potential to disrupt sound prison administration which, as this Court has often noted, is "peculiarly within the province and professional expertise of corrections officials." (27)

It should be more of a concern to the states and the federal government that there is widespread failure on the part of states, and state departments of correction, to enact the provisions of the ADA. (28) It is not acceptable that the ADA mandate should simply be waived--or considered a principle less significant than that of punishment. If it is not feasible to treat disabled prisoners fairly and without discrimination in prison settings, then alternative settings should be considered. Imprisonment is the default punishment in the United States, but whether incarceration achieves the purposes of punishment is much less certain. That the Americans with Disabilities Act is yet to be fully implemented should not mean a retreat from its principles; the opportunity and challenge is for criminal justice professionals to envision less restrictive settings in which disabled prisoners can live without constant suffering, and those who are eligible can prepare for life after imprisonment. It is, after all, generally not they who pose the greatest threat to society.

NOTES

(1) Americans with Disabilities Act, ch. 126, 42 U.S.C. [section] 12101.

(2) 42 U.S.C. [section] 12131 et seq.

(3) 42 U.S.C. [section] 12181 et seq.

(4) Debates in Congress about passage of the ADA used estimates of 40 million people in the United States affected by one or more physical or mental disabilities.

(5) Paige M. Harrison and Allen J. Beck, Prisoners in 2003 (Washington, DC: Bureau of Justice Statistics, U.S. Department of Justice, 2004), 1.

(6) Estelle v. Gamble, 429 US 97 (1976).

(7) The Prisoners Self Help Legal Clinic in Newark and Prisoners' Rights in New York, legal organizations that assist prisoners with pro se litigation, are receiving an increasing number of inquiries about ADA-based claims. Personal communication, M.L. Smith, 9/19/06.

(8) Yeskey v. Pennsylvania, 524 U.S. 206, 212 (1998) (holding that prison boot camp program was a program, service, or activity for Title II purposes).

(9) Brief by Amicus Curiae National Disability Rights Network in Support of Petitioners, US v. Georgia, 2005 WL 1811060.

(10) United States v. Georgia, Goodman v. Georgia, 126 S.Ct. 877, 163 L.Ed.2d 650 (2006).

(11) 42 U.S.C. [section] 12102 (2).

(12) "More Than 50 Million Americans Report Some Level of Disability," Census Bureau News Release, May 12, 2006 <http:/ /www.census.gov/Press-Release/www/ releases/archives/aging_population/ 006809.html>.

(13) Doris L. James, Profile of Jail Inmates, 2002 (Washington, DC: Bureau of Justice Statistics, U.S. Department of Justice, 2005) <http:// www.ojp.usdoj.gov/bjs/pub/ pdf/pji02.pdf>.

(14) Paula M. Dixon, Mental Health and Treatment of Inmates and Probationers (Washington, DC: Bureau of Justice Statistics Special Report, 1999), 1 <http:/ /www.ojp.usdoj.gov/bjs/pub/pdf/ mhtip.pdf>.

(15) Doris L. James and Lauren E. Glaze, Mental Health Problems of Prison and Jail Inmates (Washington, DC: Bureau of Justice Statistics, 2006).

(16) Department of Health and Human Services, The Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities (Rockville, MD: Public Health Service, 2005) <http://www. surgeongeneral.gov/library/disabilities/ calltoaction/call to action.pdf>.

(17) Madrid v. Gomez, 190 F.3d 990 (9th Cir. Cal. August 30, 1999).

(18) See Adam Liptak, "To More Inmates, Life Term Means Dying Behind Bars," New York Times, October 2, 2005: "More than 3,000 of the 5,100 prisoners [at Angola State Prison in Louisiana] are serving life without parole, and most of the rest are serving sentences so long they cannot be completed in a typical lifetime. Eighty-five percent of the men at Angola will die there."

(19) Harrison and Beck, Prisoners in 2003, 4.

(20) Carleton A Hornung, Robert B. Greifinger, and Soniya Gadre, A Projection Model of the Prevalence of Selected Chronic Diseases in the Inmate Population. National Commission on Correctional Healthcare, The Health Status of Soon-to-be-Released Inmates, Report to Congress (August 2002) <http://www.ncchc.org/stbr/Volume2/ Report3_Hornung.pdf>.

(21) Ronald H. Aday, Aging Prisoners: Crisis in American Corrections (Westport, CT: Praeger, 2003).

(22) National Commission on Correctional Healthcare, The Health Status of Soon-to-be-Released Inmates, Report to Congress (August 2002) <http://www.ncchc.org/ pubs_stbr.html>

(23) Arthur L. Kellerman and Knox H. Todd, "Killing Heat," New England Journal of Medicine 335 (1996): 126-27; E.M. Kilburne, K. Choi, T.S. Jones, and S.B. Thacker, "Risk Factors for Heatstroke: A Case-Control Study," Journal of the American Medical Association 247 (1982): 3332-36; "Heat-Related Mortality--Chicago, July 1995," Morbidity and Mortality Weekly Report 44 (1995): 577-79.

(24) Brie A. Williams, Karla Lindquist, Rebecca L. Sudore, Heidi M. Strupp, Donna J. Willmott, and Louise C. Walter, "Being Old and Doing Time: Functional Impairment and Adverse Experiences of Geriatric Female Prisoners," Journal of the American Geriatric Society 54, no. 4 (April 2006): 702-07.

(25) C. Seth Landefeld, Robert Palmer, Mary Anne Johnson, and Catherine Bree Johnston, Current Geriatric Diagnosis and Treatment (New York: McGraw-Hill Companies, 2004); <http://www.ahrq.gov/clinic/ uspstfix.htm> U.S. Preventive Services Task Force (USPSTF), Agency for Healthcare Research and Quality.

(26) 126 S.Ct. 877 (2006).

(27) Brief of Amici Curiae Tennessee, Alabama, Colorado, Delaware, Idaho, Michigan, Nevada, New Hampshire, Oklahoma, Oregon, Puerto Rico, Washington, Wyoming in Support of Respondent, US v. Georgia, 2005 WL 2367597.

(28) Michael Waterstone, "The Untold Story of the Rest of the Americans with Disabilities Act," Vanderbilt Law Review 55 (2002): 1807.

Robert B. Greifinger, MD, is a health care policy and quality management consultant. He was the principal investigator for a recent Report to Congress on Seizing Public Health Opportunities through Correctional Health Care.