Prison Starvation Death Raises Questions

Outraged that prison officials wouldn’t provide him with the special diets that he said conformed with his religion, Teshone Abate stopped eating last summer. Jailers got permission from the courts to force-feed him, but he yanked out the tubes.

Prison officials say they did all they could. But Abate’s death Jan. 3--the only case experts can recall of a U.S. prison inmate killing himself by starvation--leaves a question: What could and should the state have done to save Abate?

Access to the records of his 125 days in the hospital and his earlier psychiatric evaluation were not immediately available, but health workers say their options were limited all along.

Abate could have been treated against his will if the courts ruled him incompetent to make his own decisions, but doctors who examined the Ethiopian-born inmate found him competent.

The state Department of Corrections went to court anyway, arguing that it had the right to override Abate’s individual rights. The state won that round. But when Abate’s resistance led to infections, the balance shifted again, and doctors decided they could no longer keep inserting tubes and drip lines into his emaciated body.

“We attempted every known method of care and management,” said Dr. Tom Lutz, the department’s chief of medical services. “We did tie him down and restrain him, but he was still able to take out his feeding tubes.”

Even when they are restrained, patients can “twist and turn,” he added. “People can do unbelievable contortionist movements even with restraints on them,” and Abate not only “consistently pulled and yanked the tubes” but was “even biting tubes in half” while tied down.

Thin, small patients can look “like Houdini” as they wriggle out of cloth ties and leather straps, but hospitals cannot go beyond the straps without risking greater harm, said Jan Howard, a spokeswoman for St. Mary’s Hospital in Tucson, where Abate spent his last four months.

Abate accepted ice chips but was adamant about yanking out the tubes, Lutz said.

The inmate began getting infected as the tubes were reinserted over and over, Lutz said, and doctors concluded that the feedings were hurting more than they helped.

St. Mary’s is a Roman Catholic hospital with a deep respect for human life, said Judi Witter, a registered nurse who heads the hospital’s ethics committee.

The ethics committee, which is designed to address ticklish issues, was never called on Abate’s case.

“It was not a case where anybody was in conflict,” said committee chairman Judi Witter, a registered nurse. “The treatment at a certain point is worse than the alternative. Our first edict is to do no harm.”

Abate’s treatment records were not made available immediately, but court records show that he waged a long and unsuccessful fight, beginning soon after he started a 20-year prison sentence in 1987 for killing his landlady in Gilbert, a Phoenix suburb.

The Ethiopian-born Abate undertook religious fasts for as many as 40 days at a time and complained about his prison diet on religious and medical grounds.

“I have sent over 12 inmate letters to chaplain, food service and counselor, but they refused me, for their dream is only to poison me,” he wrote in one complaint. “Because of health problem of ulcer, I used to take bland diet for medical care reason.”

When he took his dietary complaints to U.S. District Court in 1989, he won the first round. Judge Stephen McNamee ordered the Arizona Department of Corrections to provide Abate with a diet that met his religious requirements.

But when Abate claimed that the state was violating the order, McNamee held a two-day hearing and concluded that Abate had gone too far. The judge ruled that the state did not have to meet any special requests as long as it offered Abate the regular prison diet choices, which included Kosher and vegetarian meals.

Abate then filed a new suit, contending that he was being harassed and denied a religious diet in an attempt to kill him. But the judge in the new case dismissed the case out of hand, citing McNamee’s previous rulings.

“In his exhaustive analysis, Judge McNamee concluded that the diet and fasting privileges requested by plaintiff are not mandated under plaintiff’s claimed religion, an Eastern Orthodox religion,” Judge Paul Rosenblatt wrote. “Judge McNamee further found that the eccentric and erratic dietary demands made by plaintiff imposed a substantial, unreasonable burden upon the ADOC and exposed plaintiff to very serious health risks. In addition, Judge McNamee rejected claims of harassment and retaliation, finding instead that plaintiff had engaged in abusive behavior.”

Abate appealed all the way to the U.S. Supreme Court, but lost at every turn. He began what prison officials described as his first hunger strike in April and dropped from 160 pounds to 100 pounds. Prison officials say they persuaded him to halt his strike briefly but discovered that he had resumed it in August.