The mother lifts up her son's left arm and releases. It flops lifelessly down to the hospital bed.
"It's his whole left side," she explains. "He can't use it." Carefully, she folds back a portion of the beige blanket to reveal a thin left leg dotted with sores. "He can move this leg a little," she says, pushing the foot slightly with her hand. "But he can't stand on it."
She basically has been living in local hospital rooms since her son was admitted early last month several hours after being released from Orleans Parish Prison (OPP). Her son was infected with HIV but fairly healthy when he was arrested and taken to OPP last December, she says. Most family members still don't know about his HIV status, and her voice automatically lowers to a whisper whenever she speaks about his medical care, even inside his own hospital room. In this story, her son will be called Robert, not his real name. On Nov. 7, when Robert was released from OPP after an 11-month stay, it took a deputy and a wheelchair to get him to the release area, she says. Her son, still lying flat on his pillow, tries to enter the conversation. His mother bends over the bed and listens closely. "He says that it was a lady deputy who pushed the wheelchair," she says, adjusting his pillow.
Robert's mother says her son has told her that when he was released, he was feeling weak and could barely stand up. One inmate had looked at the thin prison-issue slippers on Robert's feet and said, "You can't leave in those." He took Robert's slippers and gave Robert his expensive tennis shoes.
According to Robert and his mother, when Robert "rolled out" -- completed the paperwork to be released -- prison staff told him that he would have to give up the wheelchair. He stood up, but was only able to stand for a minute or two before falling down.
Another newly released inmate walked up. "It was a guy I knew," says Robert in a weak voice. "He said, 'You don't look so sturdy. I'm going to help you get out of here." The guy had Robert put his working arm around his shoulder and they walked out. OPP officially records Robert's release at 12:56 a.m.
What happened next is a muddle. "He wasn't in his right mind," says his mother. She spent that night sitting in the living room with the door unlatched, waiting for Robert to walk into the house. Her other child, a daughter eight years older, would see Robert first. Just before 8 a.m., the daughter was driving along Tulane Avenue to Charity Hospital. Not far from the main Charity entrance, she saw someone on the sidewalk, stumbling a few steps, then falling down. She realized it was her brother.
She hit the brakes, stopped the car in the middle of the road, and ignored the horns of the cars and buses while she ran over to her brother and dragged him into the car. "Probably the first thing people thought is that he was drunk," she says. Her brother, she says, was "out of his mind." For the first 10 minutes or so, he didn't even know his sister's voice, didn't recognize who she was.
Robert had mentioned to them, via telephone, that the guys in the tier thought that he'd had a stroke. But Robert's family was not prepared for the severity of what they would see. "Look at this boy. He done had a full-blown stroke," screamed the daughter as she arrived at her mother's house. Robert's mother changed his clothing while her daughter called the paramedics, who arrived almost immediately and took him straight to Baptist Hospital.
Robert's mom says that Orleans Parish Prison staff should have intervened. They should've called a family member or used some of his leftover OPP account money to put him in a cab. If she had had even an inkling about his actual condition, she says, she would've waited there all night until he got out.
"To push him out the door and say, 'You get home the best you can' -- that's cold-blooded. You don't do a dog like that."
Orleans Parish Sheriff Charles Foti says that Robert brought everything on himself. "I am truly sorry that anybody has a stroke or that anybody becomes powerless," he says. "But that is because of his lifestyle, not because of us."
Foti estimates that, of the 70,000 or so people booked at OPP each year, 1,000 or so are infected with HIV.
"I'm not a doctor and I have 6,000 people in this facility," says Foti in regard to Robert's release. "But he [Robert] wasn't infirm for most of his stay. He was seen while he was here, 30 times by a physician, 12 times by the HIV specialist. He was taken five times to HOP (Charity Hospital's HIV Outpatient Program). He was given very good care."
He was not, however, a perfect inmate, says Foti. Within the past several years, he had come through OPP more than a dozen times on different charges. On several occasions he had to be moved to different tiers for his own protection; he was a firesetter and he had tried to infect others with HIV while in custody.
Robert's family says that they never heard anything about the other incidents. They say that they've heard that it's not unusual for HIV-AIDS inmates to transfer tiers frequently, because they are often singled out for mistreatment by other inmates.
The HIV-AIDS epidemic began in the United States in 1981, when the Centers for Disease Control and Prevention (CDC) first identified AIDS. Prisons have been hit harder than almost anywhere else, says Nick Freudenberg, professor of public health at Hunter College in New York and the founder in 1987 of the college's Center on AIDS, Drugs, and Community.
"Some studies show that about a quarter of the people with HIV infection in the United States pass through a jail or prison in any given year," says Freudenberg. "That to my mind is just a staggering figure."
Freudenberg says that the rates differ for men and women, but that overall, the rates of HIV infections in jails and prisons are about 10 times higher than the general population. "The larger proportion of that is related to injecting drug use. That's because of our policies on drugs and who gets arrested," he says. "Also, compared to the general population, jails and prisons have high proportions of men who have sex with men, and women who are heterosexually infected."
In 1995, according to the Bureau of Justice Statistics, nearly one-third of inmate deaths in state prisons were attributed to AIDS. As new medication has been developed and put into use, that has dropped dramatically, to the point where only six percent of deaths in 2000 were from AIDS-related causes. That means that, like on the outside, inmates with HIV-AIDS are living longer and requiring ongoing medical attention for more extended lengths of time.
Like other prisons of its size, OPP now has HIV experts on its medical staff. There also is a separate AIDS hospice within the prison facility. Inmates with HIV-AIDS are transported for appointments, to the HIV Outpatient Program (HOP) at Charity Hospital and are also treated there when they are released.
Significant improvements in OPP's medical care came about because of an ongoing piece of litigation, Hamilton vs. Morial, the longest-running lawsuit over prison conditions in the United States. Mohamedu Jones is a lawyer for the National Prison Project of the American Civil Liberties Union, which filed this lawsuit in 1969. Health care is one of the main points of contention within the suit.
"There's no way that whatever (health care) improvements are being made would have been obtained without this lawsuit," says Jones. "It took this suit to bring in HIV specialists, gynecologists, psychiatrists and fully trained nursing staff."
OPP has made significant progress, says Jones, but it still has work to do, particularly regarding discharge planning for people with HIV. "There is no discharge planning," says Jones. "That's a failure of the sheriff and of the HIV advocates in the community," he says.
Jackie Walker, the Prison Project's coordinator of AIDS information, says that OPP is "clearly behind" in this area. Facilities that do this right, says Walker, release prisoners with HIV-AIDS prisoners with two weeks of medication and arrange for housing and transportation for people who are being released.
On a statewide level, the Louisiana Office of Public Health (OPH) is implementing this type of model with state facilities, says Beth Scalco, the HIV-AIDS director within the OPH. The city HIV-AIDS office is said to be considering such a model for Orleans Parish, but did not return phone calls for this story.
Discharge planning at OPP definitely could use some help, says Deidre Peterson, a local criminal defense attorney who works with defendants with HIV and AIDS. "I think they're trying to make an effort," she says. "But I think they're very clumsy sometimes. They just don't know what to do with these people. I don't think they're trying to be indifferent. I think they just don't know what to do." They need to learn soon, she says, "because people with HIV and AIDS are going to make up a good portion of the prison population in the next few years."
Foti says that inmates who are released currently have an appointment the very next day at the HOP clinic. He notes that most hospitals won't even let you walk to the door. "They wheel you out," he says.
But what about Robert's case, in which his mother and sister say he could barely stand up without the wheelchair? "I'll find out whether he [Robert] was unable to walk," he says.
Foti calls back a few minutes later and says that he checked with his staff and that Robert was fine when he was released. "There is no indication," says Foti, "that he had suffered any sort of stroke." If Robert had been in any sort of distress, says the sheriff, he would have been immediately taken to Charity Hospital.
Octavia Henry can tell you what Robert did for those first several hours after his release. "He sat right there all night," she says, pointing at a booth not far from the kitchen in this 24-hour restaurant, the East Pavilion. As you walk onto Charity's grounds from Tulane Avenue, the Pavilion is on the left, in the area that was once the blacks-only waiting room and then was the K through Z patient waiting room before it became a restaurant in 1985. It's a long skinny space filled with two rows of small, hard booths.
Every night, Henry can be found at the Pavilion, cooking and waiting tables during the night shift. Tonight, most of her customers wear the white pants and white shoes of hospital workers. She also sees a lot of newly released OPP inmates. "Every day," she says. "They must tell them to come here."
She remembers Robert well. "He kept falling on the floor," she says. "He told me that his equilibrium or something like that was off. I thought he was drunk."
Robert had come in around 2 a.m. or so, she guesses. The guy who brought him in ordered chicken for the two of them and explained that Robert had just come from the prison. At some point, the man left. Robert stayed on, often falling off the slick booths onto the ground before being picked up by other customers. "He didn't talk to nobody," she says. "He just sat there and looked."
"He should've told me that he'd had a stroke," Henry says. "I would have gotten him some help from the hospital."
Instead, she told him, around 4:30 or 5 a.m., that he couldn't loiter any longer in the Pavilion. "I put everybody out if they're acting drunk," she says.
Two officers from the hospital helped Robert out to the street. Henry then watched while he held onto Charity's outside fence with his arms and slowly moved himself toward that corner's bus stop. "The last time I saw him, it was around 7:30 or 8 o'clock," she says. "I was on my way home. He was on the ground inside the bus stop and a couple of ladies were picking him up."
Robert seems uncomfortable. He has been tossing and turning and flailing, often grabbing the bed rail with his right arm and turning over. But as the last ray of sun comes across his hospital room, he finally goes to sleep and his body is still.
His mother adjusts his blanket and tries to recall when she first knew that he was HIV positive. The staff at the HOP clinic had urged him to tell his mother, she says.
"I don't know when he first started going there because he didn't tell me," she says, whispering. "But one day he broke down and wanted to talk. He told me and he started crying." As to how he contracted HIV, she has no idea. "We never discussed it," she says, wiping her eyes. He never told anyone else about his diagnosis, she says. But from that day forward, she would accompany him to his appointments at the clinic. "To give him support," she says.
She looks at the young man with the hollow cheeks who stares blankly from the bed. "This is a short-term facility," she says, a tear running down her cheek. "Two or three people die here every day." She would have never pictured Robert, her baby boy, in here.
"He loved school," says his mom. He played the drums, was on the newspaper staff. "His senior year," she says, "he was senior class president. He always had a lot of friends. He was voted best dressed, most popular. He would escort a lot of the girls to the homecoming, if they needed a date. He was a happy-go-lucky guy.
"I never had to go to school for him. One of his teachers called me to tell me what a good student he was. He used to get Ebony and JET magazine, was always in good spirits, always neat, well-dressed. He had several drawers just of socks and underthings. Ties galore -- beaucoup ties."
She always appreciated that her son was so well-behaved, she says. "When he was young and growing up, I would tell him, 'I sure thank you for not bringing me through no changes.' I never had to get him out of trouble. Some parents have to do that through life, you know."
After graduation, Robert headed to the University of New Orleans. He lived on campus, but stayed in close touch with his mother and sister. Then, after three years, he quit. As he got older, into his early thirties, he started getting in trouble. "I never could figure any of it out," says his mother.
Robert's first arrest, in December 1998, seems to have coincided closely with his first visit to the HIV clinic. Maybe that was on his mind, says his mother. She says that she thinks it was around this time that he probably started smoking crack. He was arrested on too many occasions for things like public drunkenness and criminal trespassing. "It was never no big thing." she says. "But I couldn't understand any of it myself. He had never been in trouble before."
A crack-possession conviction landed him in the state correctional system for a year. In December 2001, a five-dollar shoplifting incident, which he pled guilty to, and another crack-possession charge landed him back in OPP as a parole violator. His mother says that he continued to call her two or three times a day while he was in OPP and that she and his sister saw him on visitation days.
A few weeks before he was to be released, she says, he called and said that the guys on the tier said that he was slurring and stumbling. They told him he'd had a stroke. He was having trouble carrying his food tray without tipping it, so the other men on the tier would get it for him.
He got along fine with people, she says, but he had told her he "wasn't a great mixer" in OPP. "He didn't play cards, didn't play dominoes. The other guys like to watch Cops, wrestling matches. He liked movies. Most of the time he was just up in his little bunk, reading something," she says.
She had seen him in mid-October and he had been fine. Toward the end of his most recent stay at OPP, it became more difficult to see him because he was transferred to a different tier that had different visiting hours, she says. He still sounded upbeat, she said, although he began to call a bit less because he said he was getting tired standing up. She had no idea what shape he was in, she says.
A hospital worker opens the door and brings a waft of gravy with her as she enters with a mauve-colored plastic dish.
Robert stirs in his bed. He puts his right arm up on the bed rail again and tries to pull himself into a position to watch TV. His sister, just off work from Charity, walks in the door. She and his mother talk about his upcoming 38th birthday. He had been looking forward to lots of home-cooked food and a big celebration. Now, the party has been moved to this room at Mercy Baptist, with a few balloons, some cake, and his immediate family.