Alabama prison officials have troubling history of issuing ‘do not resuscitate’ orders without consent

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Alabama prison headquarters

Adeshina Emmanuel

Alabama Department of Corrections headquarters, in Montgomery, Alabama.

Billy Smith is not the only inmate who died after Alabama prison officials gave medical staff a “do not resuscitate” order.

The Alabama Department of Corrections has a documented history of issuing orders not to resuscitate critically injured or ill prisoners without consulting with families.

In a 2014 lawsuit, two civil rights organizations contended in a federal lawsuit that the prison system has made end-of-life decisions to “numerous” prisoners without their consent.

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In another suit, the family of Marquette Cummings sued the prison system in 2015 after doctors took him off life support under instructions from a warden. That case led to a federal appeals court decision: Wardens do not have the power to make  life-and-death decisions for prisoners.

Cummings was stabbed in the eye by another inmate at St. Clair Correctional Facility on Jan. 6, 2014, according to court records. Authorities then took Cummings to the University of Alabama-Birmingham Hospital in critical condition.

His mother, Angela Gaines, learned of the attack and called the prison for information. But it took hours before the warden, Carter Davenport, returned her call, according to the lawsuit.

Even then, the lawsuit contends, the delays persisted: It took several hours before Davenport told Gaines the hospital where authorities had transported Cummings. And at the hospital, Gaines had to wait another 90 minutes before she was allowed to see her son.

When she finally saw her son, Gaines said, he responded to commands from her, such as “blink if you can hear me.”

But hospital staff contended his brain was barely functioning. That evening a hospital staff doctor issued a “do not resuscitate” order for Cummings. That order, according to hospital records, was based on instructions from the warden that “no heroic measures be taken.”

Cummings was removed from life support and stopped breathing about 7 p.m. on Jan. 7, 2014, a day after arriving at the hospital.

Gaines then filed a federal lawsuit against the prison system, hospital officials, and Davenport personally. U.S. Magistrate John Ott agreed to dismiss most of the defendants. But he ruled that Gaines’ claim that Davenport had committed “deliberate indifference” to Cummings’s medical needs could proceed.

In 2018 the 11th U.S. Circuit Court of Appeals rejected Davenport’s appeal, ruling the warden lacks the authority to make end-of-life decisions for prisoners.

The case then went back to the trial court  last year after Davenport unsuccessfully asked the U.S. Supreme Court to review the case.

In December, court records show, Gaines settled her lawsuit against Davenport.

In addition there remains the class-action lawsuit against the prison system, filed by the Southern Poverty Law Center and the Alabama Disabilities Rights Program, contending the state has failed  “to provide constitutionally adequate medical care” to prisoners.

The Alabama Department of Corrections, which switched from one controversial health care provider to another in 2018, has resolved several issues in the complaint, agreeing to measures to improve conditions for inmates with disabilities and inmates with mental illness.

But among the unresolved allegations  is the claim that prison officials “have a policy and practice of allowing doctors to discontinue care to terminally ill prisoners against their will.”

“Numerous prisoners have been given ‘Do Not Resuscitate’ orders (‘DNR’) or ‘Allow Natural Death’ orders (‘AND’) without their consent or even their knowledge,” the suit reads.

“In some cases, the doctors have discussed this issue with prisoners, the prisoners have affirmatively declined to be DNR or AND, but have been made DNR or AND regardless of their refusal. In some cases, individuals have been persuaded to sign DNRs without knowing what they were signing.”