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Congratulations to Dr. El-Sayed and his co-authors on their impressive and important study on the causes of mortality from incarceration. Collecting 30 years worth of incarceration and cause-specific mortality data is comprehensive. I would like to make some brief comments on this report but I must do so in the context of full disclosure.

I practiced medicine for 30 years, 25 of those in the Emergency Center at St. Joseph Mercy Hospital. In 1992, I founded SecureCare a correctional medicine service with the mission of providing quality medical care to inmates in jails, prisons and juvenile detention centers. We served the Washtenaw County Jail and several other detention facilities in Michigan and Ohio.

I completely agree with the issues identified in this study and I support all of the corrective measures recommended by Dr. El-Sayed to reduce the numbers of un-necessary deaths. It is undeniable that lacking and inadequate medical care is a contributor to increased deaths in the incarcerated population. However, the deaths are multifactorial and many of those that are causative are outside the scope of medical intervention; the doctor has no cure or therapy for poverty, racism, cultural factors or even for suicide, alcoholism and drug overdose.

The solution needs to be comprehensive and long lasting. I believe the time is right to achieve those corrective measures. Eli Savit, the recently elected Washtenaw County Prosecutor, ran on a platform endorsing the same remedies as Dr. El-Sayed. He acknowledged that people are regularly imprisoned because of poverty, mental health issues or addiction. He pledged to consider all relevant factors when making a decision about charging and sentencing. He wants to end cash bail and to treat all defendants with equal justice.

I feel much like I did in the mid 60s when the social issues were civil rights, the Vietnam War and women's liberation. Change is in the air and those with courage and vision will lead us.

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