Available From UC Press

In 1976, the Supreme Court affirmed incarcerated people's right to health care under the Eighth Amendment. Wards of the State examines the everyday instantiation of this right in a maximum-security men's prison in Pennsylvania. Drawing on two years of ethnographic fieldwork, Nicholas Iacobelli examines how the prison's medical unit operates as a "ward of the state"—a site where the state's ideologies are reproduced when its obligation to care collides with its role to punish.

Incarcerated men are also wards of the state in the sense of being cast as its biological and financial property. This dynamic creates a complex system of dependence, refusal, and skepticism, as well as troubling ideas of what constitutes health and illness in prison. Despite this, the right to health care opens spaces for men to envision futures and to make both personal and structural appeals to justice—with both tragic and hopeful consequences.
 

Nicholas Iacobelli is Assistant Professor in the Division of General Internal Medicine at the University of Washington, where he cares for hospitalized patients and conducts anthropological research on the intersection of carcerality and health.
 

"Despite decades of case law and legal theory about what constitutes a 'serious medical need' and 'cruel and unusual punishment,' when it comes to health care for incarcerated individuals, these questions have been begging for ethnographic engagement to understand how they are enacted in the everyday realities of prisons. Wards of the State does just that, providing new depth in its analysis of the legal preconditions of carceral care, grounded in excellent scholarship and sophisticated writing."—Carolyn Sufrin, author of Jailcare: Finding the Safety Net for Women Behind Bars"Nicholas Iacobelli's novel contribution gives us direct and rich insight into the lives of incarcerated men, tracing the legacy of prison health care back to slavery and racialized forms of state punishment. With nuance and respect, he captures the fraught encounters between these men and the people tasked with providing care within this system."—Kimberly Sue, Assistant Professor of Medicine, Program in Addiction Medicine, Yale University School of Medicine"This brilliant, ethnographic deep dive inside a Pennsylvania prison should be required reading for judges, lawyers, prosecutors, medical students, anthropologists, and anyone concerned about social justice and the absence of civil rights transparency in US carceral facilities. Iacobelli, an internal medicine doctor and anthropologist, shadowed clinicians for two years as a graduate student. He documents the worst-case neoliberal model of semi-privatized carceral health care inside public state correctional facilities. Private predatory carceral medical provider corporations are incentivized to maximize profits through capitated subcontracts and routinely deny urgently needed care to deathly ill inmates. In the punitive institutional environment, arrogant, or merely clueless, clinicians label patients 'undeserving' and 'manipulative' simply for requesting essential health care. Empathetically, Iacobelli highlights the illness travails of eloquent 'legal eagle' aging prisoners. Anticipating lawsuits, guards and prison administrators vengefully transfer deathly ill men who file grievances into grotesquely overcrowded 'Restrictive Housing Units.' Privatized corporate carceral healthcare administrators discipline their clinicians to routinely 'delay-and-defer' expensive treatment requests, akin to (but much worse than) the standard practice of US managed care providers in 'free America'—it is much crueler and lethal for patients behind bars with no health alternatives. With erudition and clarity, Iacobelli also takes readers through the convoluted, arcane history and hyper-punitive ideological logics of US case law that have given birth to, and that are sustaining today, the torturous nightmare of US mass incarceration."—Philippe Bourgois, coauthor of Righteous Dopefiend and author of In Search of Respect: Selling Crack in El Barrio"Wards of the State is a beautifully written and masterful analysis of health care inside Pennsylvania's largest prison. It is a bracing and nuanced account of how the for-profit healthcare system alleviates some suffering while routinely perpetuating abuse, cruelty, indifference, and injustice."—Marie Gottschalk, author of Crime and No Punishment: Wealth, Power, and Violence in America