The rampant spread of the coronavirus through prisons and jails in Arkansas resulted in several large outbreaks numbering in the hundreds of cases, yet numbers of deaths have varied from one location to another, according to records of the state Department of Health.
At the Cummins Unit state prison in Lincoln County, for example, 963 prisoners tested positive for the virus and 10 died. Meanwhile, at the Federal Correctional Institution in Forrest City, an outbreak among 764 prisoners resulted in no reported deaths.
Both outbreaks reached their peaks in active cases more than a month ago, and the Health Department considers almost all of the survivors at both prisons to be recovered because it has been more than two weeks since they first tested positive.
Corrections experts said the most likely explanation for deaths at Cummins and the absence of them at the federal prison has to do with the ages and backgrounds of the inmates housed at each location in addition to the quality of health care provided.
Molly Smith, a professor of criminal justice at the University of Arkansas at Little Rock, said state prisoners are more likely to be serving lengthy sentences or to have been in and out of prison, so they are less likely to have received quality health care in the past.
State inmates, she said, also are more likely to have a history of violence or substance abuse than federal inmates, who she said are more likely to have been involved in white-collar or interstate crimes, such as trafficking.
"Their health care history [at federal prisons] is probably a little stronger than what you see in state facilities," Smith said.
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Of the 10 men who died after contracting covid-19 at Cummins, all but three were age 60 or older. The youngest, a man named Derick Coley, was 29 and died after an "incident" in his barracks that involved other inmates starting trash fires and breaking glass, according to a coroner's report.
One man at the Randall L. Williams Unit in Pine Bluff, 73-year-old Jimmy White, died in May after contracting covid-19, according to a coroner's report. He was one of 286 inmates at the facility to test positive for the coronavirus; most of the inmates there are considered recovered.
Both worldwide and in the United States, about 5% of confirmed covid-19 cases have resulted in death, according to statistics compiled by Johns Hopkins University.
State health officials, including Health Secretary Nate Smith, have said that prison populations tend to skew younger than the general public, which could help blunt the severity of outbreaks. However, other health and corrections experts have pointed out that people in prison often have underlying health issues that could place them at greater risk.
"People in prison age faster," said Sharon Dolovich, a professor at the University of California, Los Angeles School of Law who has led a project to track the spread of the coronavirus in American prisons. "If you're 50 in prison, you probably have the body of a 65-year-old or older."
The average age of prisoners at both Cummins and the federal prison at Forrest City is in the early 40s, according to the agencies that run both prisons. The average age is slightly higher at the federal prison.
In an email, federal Bureau of Prisons spokesman Justin Long wrote that Forrest City is a Medical Care Level 2 facility where "inmates are stable outpatients who require clinician evaluations monthly to every 6 months. Their medical and mental health conditions can be managed through routine, regularly scheduled appointments with clinicians for monitoring."
Although the federal prison at Forrest City does not have an infirmary, Long said that in-house medical care is handled by the institution's Health Services Department.
At Cummins, as at all Arkansas Department of Corrections facilities, in-house medical care is contracted to Wellpath, a private company based in Nashville, Tenn.
Dolovich, the law professor, said that for-profit medical providers such as Wellpath have a poorer track record compared with government-run medical care at prisons. Even in a pandemic, she said, the companies have incentives to keep up profits by providing fewer medical services.
"What these numbers say to me is an indictment of the quality of medical care in the Arkansas prison system," Dolovich said after comparing mortality rates at Cummins and the federal prison at Forrest City.
In a statement Friday, Wellpath's chief clinical officer, Dr. Thomas Pangburn, defended the company's care for prisoners in the "complexity" of a confined prison setting.
Asked why Cummins had a higher mortality rate than other prisons, Pangburn cited federal privacy laws and declined to address individual cases.
"Wellpath's doctors and nurses worked around the clock to adapt and develop effective protocols, so much so that the [U.S. Centers for Disease Control and Prevention] came to us to understand our approach," Pangburn said. "Their subsequent guidelines for correctional health were informed by some of the experiences and good work done by Wellpath's doctors, nurses and administrators."
The federal system operates about four times as many prison beds at dedicated medical facilities when compared to the Arkansas Department of Corrections, even when adjusting for overall size, according to data from both agencies.
The Arkansas Department of Corrections operates the 120-bed Special Needs Unit, a medical facility for males adjacent to the Ouachita River Unit in Malvern. (One prisoner with covid-19 being treated at the facility was transferred from Cummins.) A smaller facility for women is a part of the McPherson Unit in Newport.
"Geriatric inmates are housed in most units," said Department of Corrections spokeswoman Cindy Murphy in an email. "Only those needing assistance with [activities of daily living] are transferred to the Special Needs Unit."
One man who was recently released from the low-security unit at the federal prison at Forrest City, 54-year-old James Flannery, expressed surprise that inadequate medical care has not contributed to more deaths.
While most of the inmates there are in their 30s or 40s, Flannery said, at any given time he saw about 25 inmates in wheelchairs and the same number, or slightly more, who relied on walkers.
Flannery, who was imprisoned for illegally working and drawing disability payments at the same time, was released earlier this month to serve three years of probation, several months ahead of his scheduled release in November.
"The [Bureau of Prisons] always thought it was our -- you know, the inmates' -- responsibility to take care of these guys," Flannery said in a phone interview Thursday from his home in Gerald, Mo. "There were some of them there that needed to be in the hospital ward, not there."
While the state Health Department lists all but 16 covid-19 cases at the Federal Correctional Institution in Forrest City as recovered, Flannery said that at the time of his release on June 9, a makeshift covid-19 ward for the very sick, located in a former vocational-technical center, was full of people.
Meanwhile, active cases have ballooned to 550 at a nearby state prison, the East Arkansas Regional Unit in Brickeys. Three other state prisons have reported smaller numbers of active cases. No deaths have been reported at any of those facilities.
In response to a request for an interview with a Department of Health official about why mortality rates varied between facilities, a spokeswoman for the Health Department referred comment back to the corrections agencies.
"That is an assessment that public health officials should be making," said Holly Dickson, the interim director of the American Civil Liberties Union of Arkansas. "What's the difference and how do we save lives?"