The Jail Cell or the Ambulance?

In a three-year stretch, Baltimore central booking turned away 2,600 people arrested by police, but found by corrections officers to have serious injuries or illnesses.

When Marilyn Mosby announced charges against six officers in the death of Freddie Gray, one of the most harrowing elements was her narrative of his ride to the Western District Police Station. Five times, Gray asked for medical help. First, when he was arrested, he complained he couldn’t breathe and asked for an inhaler. At the third of four stops, he indicated at least twice that he needed medical help, Mosby, the city prosecutor, said. He was given none, and by the time he arrived at the police station—unable to breathe and in cardiac arrest—it was too late. He was taken to a hospital, slipped into a coma, and died a week later.

Why didn’t officers get medical help? Apparently, at least one of them had already diagnosed his condition: “Jailitis.”

That’s the term police use when they think a prisoner is faking an illness or injury to avoid going to jail. In an investigation published over the weekend, The Baltimore Sun reports that officers in Charm City either disregard or don’t notice serious injuries or ailments among people they have arrested with surprising frequency.

According to state statistics, officers at the city detention center have refused to book almost 2,600 prisoners over the last three years—a significant number, though still only about 2 percent of total bookings. The medical conditions include broken bones, drug overdoses, need for dialysis, and even a human bite. Of the total, 123 had head injuries. (The Sun produced an excellent interactive graphic where you can explore the cases.)

Why would central booking turn the suspects away? Booking takes four to five hours in normal circumstances, so corrections officers want to make sure people are up to the ordeal, a spokesman told the Sun. It’s also a matter of cost: Once a prisoner is taken in, the detention center is responsible for providing medical care to them and shouldering the cost, since prisoners are constitutionally entitled to health care.

No one seems to doubt that prisoners do sometimes fake injuries; it’s conventional wisdom among police going back to before Gray’s death, as the ready slang term “jailitis” demonstrates. The question is how frequently it really happens, and how effectively police are able to tell the difference. In Baltimore, the answer appears to be that they’re especially bad at it.

One problem is that while police are trained first responders, they are not medical personnel, and they are ill-prepared to treat suspects. But the adversarial relationship of mutual distrust between police and suspects has to play a role in explaining the problem, too. When officers make arrests, they assume the detainees have committed crimes, and are likely to suspect that pleas for medical attention are mostly lodged to avoid jail.

In Baltimore, where there is serious and longstanding tension between the black community and the police department, there appears to be an elevated risk of improper arrests—for example, Mosby said Gray committed no crime, and she has charged officers with false imprisonment for arresting him. And in Baltimore there is also a long and ignominious history of police brutality. Those currents meet in the case of refusing medical attention to detainees:

The Sun's examination of more than 100 lawsuits against officers— in which the city paid more than $6 million in court judgments and settlements—found that dozens of residents accused police of inflicting severe injuries during questionable arrests and disregarding appeals for medical attention.

The newspaper also found that in other localities—including New York and Cleveland, both of which have also seen accusations of excessive use of force and other civil-rights abuses by police—there’s no comparable problem, and police are faster to seek medical care.

The swift and aggressive decision to charge the officers in the Gray case may make police faster to seek medical attention for detainees. Mosby charged officers with crimes including second-degree depraved heart murder, manslaughter, and assault, as well as misconduct and false imprisonment. While experts think Mosby may have overcharged the suspects, the possibility of quick prosecution will likely make officers err on the side of caution in the future. (Also over the weekend, attorneys for the charged officers called for Mosby to leave the case, citing what they called conflicts of interest.)

Police work today is ever more sophisticated. It’s not just walking the beat and having good intuition. Enforcement areas are pinpointed with mathematical precision, officers are redeployed and rearranged by algorithms, and arrest numbers are crunched and analyzed to reveal elaborate trends. The story of Freddie Gray’s death is proving a clear demonstration of the limitations of CompStat policing. Even as law enforcement adopts more elaborate methods of patrolling, the most fateful decisions are the ones officers make in the heat of the moment, without the benefit of data: Does that guy look like he’s doing something illegal? Is this woman lying when she says she doesn’t feel well? That means police have to be both well-trained to spot medical emergencies and worthy of public trust that they’ll make responsible decisions. In Baltimore, too many officers appear to be failing both tests.