And a Supreme Court decision is likely to help keep it that way

A new FAQ and blog post released by the Center for Justice & Democracy at New York Law School exposes the state of healthcare in American prisons today. To the surprise of no one, it’s abysmal.

Recent lawsuits have revealed incredible stories of malfeasance, indifference, and incompetence. In one case, an inmate with a bump the size of a tennis ball on his arm, began going numb and twitching uncontrollably. He soon felt “his intestines escaping from his rectum.” A prison nurse gave him Tylenol and used K-Y Jelly to push his intestines back in, and then sent him to his cell. Hours later, doctors at a local hospital diagnosed him with an abscess which was compressing his spine. In another case, an inmate suffering from diabetes spent nearly a week in a cell without food, water, or his insulin. He died shortly after. The two largest prison healthcare providers have been sued over 1,750 times in the past five years.

But just as worrisome is the number of lawsuits which were never brought.

A report produced by Alliance for Justice earlier this year describes the labyrinth inmates must navigate in order to sue prison officials for medical malpractice and other constitutional violations—and how a misstep could lock them out of the courthouse doors forever. Under the Prison Litigation Reform Act (PLRA), enacted in 1996 to “solve” the non-existent problem of runaway frivolous litigation, inmates essentially lose the ability to sue in civil courts once they have had three previous civil cases “dismissed on the grounds that it is frivolous, malicious, or fails to state a claim upon which relief may be granted” (the so-called “three-strikes” rule).

In the two decades since its passage, federal courts have expanded nearly every aspect of the PLRA. Many courts give multiple “strikes” in a single case, strikes for procedural missteps, strikes in cases that go to trial, and even strikes in cases where the inmate wins a settlement. The Supreme Court exacerbated the problem this term by even further expanding the three-strikes rule in Coleman-Bey v. Tolefson.

The law leaves victims of medical malpractice in prison with a difficult choice: sue the prison and risk losing and never being able to sue for prison misconduct again, or continue to suffer in silence. Many already have the choice made for them. For those with three strikes, there’s virtually no judicial recourse available at all.

The PLRA was passed because lawmakers believed too many inmates were suing. But as the new report from CJ&D suggests, maybe the real problem was too many prisons deserved to be sued.