Alabama’s prisons are underprepared to prevent and manage the spread of COVID-19, prompting a worst-case scenario plan that could call on the National Guard to work in the prisons should the virus take hold in the system, according to an internal Department of Corrections document obtained by AL.com.

The 263-page planning document states that the physical design of Alabama's prisons, severe overcrowding and understaffing combine to make it impossible to follow recommended protocols for keeping prisoners and employees from contracting the coronavirus.

In the worst-case scenario outlined in the plan, system-wide shortfalls could result in widespread infection, the need for military intervention and nearly 200 inmate deaths. And the plan shows that the department anticipates that it may need to spend more than $2 million on supplies to respond to the pandemic, including personal protective equipment, medication and body bags.

AL.com obtained a copy of the document, dubbed 2020 Pandemic Continuity of Operations Plan, on Thursday, the same day some officials first received it via email. The document was dated April 1 and signed on that date by Ruth Naglich, the department’s associate commissioner for health services.

Inmates and their families, correctional officers, attorneys, journalists and other stakeholders have been asking the department about the impact of coronavirus on the state prison system and its nearly 22,000 inmates for weeks. Epidemiologists, professors and other experts have been ringing alarm bells about the need for Alabama and other states with overcrowded prisons to take swift, decisive action to keep coronavirus from spreading behind bars and killing large numbers of prisoners.

In a telephone call Friday night, DOC Commissioner Jefferson Dunn said he and the department he runs are doing everything in their power to avoid such a result in Alabama.

"The number one thing in my mind is safety, is trying our best to prevent the virus from getting into the facilities, and then mitigating the impact," he said.

But the DOC has provided little in the way of information about how it is managing the crisis, beyond three written statements since March 19 that failed to address many concerns about its coronavirus response. The DOC planning document was dated nearly three weeks after Gov. Kay Ivey declared a state of emergency in response to coronavirus on March 13, the same day her office released a statement about Alabama’s first confirmed COVID-19 case.

The department says that none of its prisoners have been diagnosed with COVID-19. It recently posted a chart on its website detailing the amount of testing for the virus that has been undertaken in its facilities. The chart showed that only 17 state prisoners had been tested for the virus as of Tuesday. Twelve of those tests came back negative and the results of the other five were still pending, according to the chart.

The department, which operates more than two dozen correctional facilities across the state, reported on Wednesday that two of its employees had tested positive for coronavirus as of that date.

The planning document characterizes prisoners as being at “Very High” risk of being exposed to the disease and says it is “unrealistic to assume cases of COVID-19 will not be found within one or more ADOC facilities.”

The department states elsewhere in the document that "[w]ithout containment and in consideration of underlying risk factors … the projected potential deaths within ADOC inmate population" due to COVID-19 total 185.

Crowded conditions

Alabama's state prisons were not designed for anywhere near the number of inmates they currently hold, and the strain on the system makes it more difficult to stop infectious diseases from spreading, according to the document.

"It is expected that the current limitations within our prison system, which typically relies upon open-bay and double-bunk dormitories housing 150 to 200 inmates each, may accelerate the transmission of disease among the inmate population, as well as the ADOC staff," it states.

Elsewhere, the document states that the reality of approximately "21,900 inmates being housed in crowded dormitories create[s] a Very High Exposure Risk situation."

Conditions in Alabama’s prisons have long been decried by inmates and advocates as inhumane and dangerous. That scrutiny has intensified since April 3, 2019, when the U.S. Department of Justice alleged that the state’s prisons were plagued by unconstitutional levels of violence and sexual abuse.

In recent years, state leaders have debated a proposal first floated by former Gov. Robert Bentley to shutter Alabama’s aging prisons and replace them with a handful of mega-prisons that estimates suggest would cost the state more than $1 billion. Ivey has pushed an updated version of the proposal and in February 2019 announced her administration was seeking bids to build three regional mega-prisons, but progress toward implementing such a plan has been slow.

Dunn said that the overcrowding makes it impossible to follow social-distancing guidelines within DOC facilities.

"We're 170 percent overcrowded and you've seen the pictures," he said. "There's not enough physical space in our system right now to do the six-feet distancing, so then what do you do?"

He said that before anyone enters one of its facilities, the DOC is requiring their temperatures be taken, and if they have a fever or other symptoms of illness, they are turned away. The document states that housing units and common spaces should be cleaned and sanitized twice daily.

The plan lays out protocols for quarantining or isolating prisoners who are diagnosed with COVID-19, prisoners suspected of having the disease and newly arrived inmates. But it anticipates that some facilities will not have enough space to quarantine or isolate everyone who falls under those categories.

"If the number of quarantined individuals exceeds the number of individual quarantine spaces available in the facility, be especially mindful of those who are at higher risk of severe illness from COVID-19," the document says.

It also states that there is not enough personal protection equipment (PPE) for everyone in Alabama's prisons who may need it:

"Infection control supplies … would not be available at levels required to address inmate needs during a pandemic event" and "[t]he assurance of available PPE supplies cannot be guaranteed to staff other than direct health care providers at this time."

Dunn said that while many people working and living in state prisons currently do not have access to sufficient personal protective equipment, the department is working to fill that gap.

"The supplies, as you know, are low. We are seeking supply chains to our vendors and other ways but as we wait on those, we're also making it ourselves and by probably the end of next week we'll have that distributed out. And we're going to start with our staff and then those inmates that are most vulnerable and then the entire inmate population," he said.

The DOC announced on its website Wednesday that inmates in work plants in two Alabama prisons had begun sewing facemasks for staff and inmates to wear and that the department expects them to be able to produce 2,000 to 2,500 masks per day. The prisoners are making simple cloth masks, not the higher-grade N95 masks that health experts recommend medical professionals wear when caring for COVID-19 patients.

The document says that even prison health care workers may not have access to N95 masks and other personal protective equipment.

"Major distributors in the U.S. have reported shortages of PPE, specifically N95 respirators, facemasks, and gowns,” it states. “Alternatives due to shortages should be considered. Facemask should be used if respirator not available. Respirators are expected with confirmed COVID-19 cases, as available. Prioritize use of PPE if shortage is significant."

Dunn said that the cloth masks inmates are producing offer meaningful protection from the virus.

"These masks have been looked at by the [Alabama] Department of Public Health and they have been indicated that yes, [they] can prevent droplets from going from one person to another," he said.

"So, I guess the question is if I don't have anything else right now, would you rather I don't do that? Of course not. We do what we can with what we have immediately while we're trying to pursue and find better and more equipment and supplies."

Staffing issues

If the coronavirus outbreak becomes severe enough, the planning document states that the DOC expects that up to 50 percent of correctional officers, contracted medical professionals and other workers in the prisons could call out of work at the same time. That level of absenteeism could leave the already understaffed facilities unable to operate without outside assistance.

"ADOC would not be able to hire enough security personnel to adequately ensure the primary mission essential functions relative to facility security and public safety are performed during a pandemic event," the document states.

"ADOC would be forced to request outside assistance from other state law enforcement agencies, as well as the Alabama National Guard to ensure facility security and public safety are maintained," it says elsewhere.

In fact, the document states that an agreement is already in place to provide for members of the National Guard to fill "perimeter posts" if necessary. But the plan states that members of the Guard would likely also need to work inside the prisons.

The combination of widespread absences among prison health care workers and the surge in inmates needing medical attention due to COVID-19 symptoms would also greatly strain the system's ability to provide adequate health care to inmates, according to the document.

"Competition will increase for health care resources and supplies that are already in short supply, including health care personnel and medication," the document states.

"Health care operations will focus on critical care issues. The opportunity to meet all routine health care needs of the inmates will be severely compromised."

The document also includes a table called "Care and Treatment Supply List" that lists supplies with a total cost of $2.3 million. It lists a wide range of items that the DOC and Wexford Health Services could have to purchase to respond to a bad coronavirus outbreak in the prisons, including thousands of wipes, gloves and paper towels, 300 COVID-19 diagnostic tests, 1,300 boxes of N95 masks and 312 body bags.

‘Woefully underprepared’

Experts say that prisons and jails are breeding grounds for disease, and correctional facilities across the U.S. including the jail complex on Rikers Island in New York City are already experiencing outbreaks of COVID-19.

Dr. Sarah Fortune, chair of the Department of Immunology and Infectious Diseases at the Harvard T.H. Chan School of Public Health, wrote in an open letter that it is vital that leaders immediately take decisive action to stop coronavirus from running rampant through prisons and jails.

"As state and local officials work to mitigate the threat of the disease, they must take proactive steps to reduce their detained populations before an outbreak occurs," she wrote. "Failure to act now will endanger the lives of both detained and non-detained people alike."

The Alabama prison system is particularly ill-equipped to stop the spread of coronavirus, according to Amy Kimpel, an assistant professor at the University of Alabama School of Law and director of the school's Criminal Defense Clinic.

"Obviously the more overcrowded facilities are, the more difficult it is to deal with any infection. If it does get into the prison system, with how overcrowded and understaffed Alabama prisons are, I worry that that’s a real recipe for disaster," she said.

Jenny Carroll, the Wiggins, Child, Quinn & Pantazis Professor of Law at the University of Alabama School of Law, said she and her colleagues have heard from numerous correctional officers and inmates in Alabama prisons who worry the DOC is "woefully underprepared" for coronavirus.

Dunn said the DOC is following the recommendations of the U.S. Centers for Disease Control and Prevention.

"If you look at and go compare what we're doing with the CDC guidelines on correctional facilities, we are almost in lockstep with them to the max extent that we can be," Dunn said. "If there's things we can do better, great. Bring them on."

But Carroll said that if COVID-19 spreads widely within Alabama prisons, it would ultimately strain the limited resources of hospitals across the state.

"If all these people get infected, we know a certain percentage of them are going to require a higher level of care than is available in these facilities. So they are going to burden hospitals that are already under stress," she said.

"They’ll either have to start taking inmates to free-world facilities for care or the alternative is you're going to start seeing the bodies pile up."

The DOC needs to move quickly if it hopes to avoid grim outcomes, Carroll said.

"We need to be thinking about housing alternatives. Other jurisdictions have been looking at empty hotels and empty dorm rooms and the advantage of this is it allows people to maintain social distancing and allows for better hygiene," she said.

Another option would be to release nonviolent offenders and people with compromised immune systems and other major health issues from custody, either via parole, furlough or other means, according to Kimpel. That would greatly reduce the chance of infection for the prisoners most at risk of contracting the virus while cutting the prison population, which would reduce strain on prison health care facilities and resources while allowing for more social distancing among inmates.

On March 20, the DOC announced it was halting the transfer of inmates from county jails to state correctional facilities for 30 days to help mitigate the spread of coronavirus. On Tuesday, Ivey issued a proclamation encouraging “local officials” to help slow the spread of COVID-19 by reducing “the number of local inmates held in county jails in a way that does not jeopardize public safety.” She did not propose releasing state prisoners.

States including California, Michigan, New Jersey and New York have selected subsets of prisoners – i.e. the elderly, those who have severe medical conditions, or those who have little time remaining on their sentences – to release in response to the coronavirus.

"To whatever extent possible, reduce the population," Kimpel said. "We need to get folks at least temporarily furloughed who are in those high-risk situations."

Fortune echoed such statements in her open letter.

"Anybody detained for a non-violent offense or who does not pose an immediate danger to themselves or others should be released immediately, before an outbreak occurs," she wrote. "This is especially true of medically vulnerable people, including elderly, immunocompromised, and pregnant individuals."

If the DOC does not take meaningful action now, Carroll said she worries that COVID-19 could kill hundreds of people in Alabama prisons.

“If the estimate is 185 [deaths], I would say that’s low,” she said. “I’m talking to people in New York and what they’re telling me is the rate of infection they’re seeing among the incarcerated population in New York is eight to 10 times what they’re seeing in the free population.”