Recap: Novel Justice with Homer Venters
Outbreak Behind Bars
Earlier this year, the Wilson Center for Science and Justice, in partnership with Duke Law's Health Justice Clinic and the Duke Decarceration Project, welcomed Dr. Homer Venters for a powerful conversation in our Novel Justice Series, highlighting his latest book, Outbreak Behind Bars: Spider Bites, Human Rights, and the Unseen Danger to Public Health.
In conversation with Dr. Lauren Brinkley-Rubinstein, Dr. Venters explored how public health failures inside jails and prisons are not isolated incidents, but are systemic, predictable, and preventable. Drawing on decades of experience as a physician, monitor, and correctional health leader, Venters reframed “outbreaks” as more than infectious disease events. Incarceration itself, he argued, creates environmental conditions that contribute to illness and death, from untreated withdrawal and diabetes to heat stroke, scabies, foodborne illness, and COVID-19.
A central theme of the talk was that health risks behind bars are not evenly distributed. Solitary confinement units, overcrowded dorms, understaffed infirmaries, and facilities without air conditioning create concentrated zones of medical neglect. Even deaths labeled as "natural causes" actually stem from identifiable systemic failures such as lack of screening, inadequate training, insufficient discharge planning, and the absence of independent oversight. "When someone dies behind bars and it’s labeled ‘natural causes,’ that’s often the end of the story. But if we look at the environmental risks, the training gaps, and the systemic failures, we see these deaths are anything but natural, said Venters.
Venters discussed how ordinary institutional routines can produce catastrophic outcomes. In county jail, for example, where many deaths that occur happen within the first 3-10 days, simple, evidence-based intake processes could prevent withdrawal deaths and other crises.
The conversation also examined legal standards of care, including access to life-sustaining medications such as HIV treatment, hepatitis C cures, and medications for opioid use disorder. Venters was unequivocal: stopping life-sustaining medication when someone enters custody is a gross deviation from accepted medical practice. However, it becomes more complicated when carceral facilities choose treatments that are different than what the incarcerated person received in community care. While litigation has pushed some systems toward reform, sustainable change requires structural transparency, independent monitoring, and accountability beyond individual lawsuits.
Importantly, Venters challenged public health professionals, particularly those monitoring and responding to health incidents in carceral facilities, to adopt practices long embedded in legal advocacy, particularly confidential, structured interviews with incarcerated people. Too often, investigations rely primarily on administrative accounts rather than the lived experiences of those directly affected.
Throughout the discussion, a broader truth emerged. "Outbreaks behind bars don’t stay behind bars," said Venters. "Public health failures inside jails and prisons ripple into our communities.” Staff return home each day. Incarcerated people reenter their communities. Failures of care in correctional settings ripple outward, shaping public health outcomes far beyond prison walls.
The event concluded with a candid exchange about burnout, structural reform, and the tension between improving conditions inside facilities and advancing decarceration. Venters underscored that both goals matter. Protecting people’s health while they are incarcerated and reducing unnecessary incarceration are not mutually exclusive, they are interconnected public health imperatives.
Outbreak Behind Bars highlights systemic failures and identifies practical steps to advance health equity in jails and prisons. We are so pleased that Dr. Venters visited Duke to explore these topics with our students, faculty and staff. Learn more about the book here.