ABOLITION
EVERYDAY SH!T: THE PILOT ISSUE
Content Notice: gun violence, incarceration, prison, medical trauma, medical neglect
Sickle cell anemia testing at the Black Community Survival Conference, March 30, 1972 | Photo by Bob Fitch | Source: Bob Fitch Photography Archive, Stanford Libraries. | Read more on Black Panther Healthcare Liberation Strategies in Alondra Nelson’s Body & Soul.
In late February 2025, a police shootout in a hospital two hours outside Philadelphia left four people injured and two dead, after a man took several medical workers hostage in a horrifying attack following his wife’s death in the intensive care unit the previous night. Reactions to this latest illustration of the disturbing rise of violence in healthcare followed predictably narrow-minded patterns of carceral thinking. Pennsylvania governor Josh Shapiro quickly praised law enforcement for being there to “save the lives of others.” Nearby hospitals soon launched police-focused public relations campaigns, announcing they were “strengthening . . . partnership with local law enforcement,” implementing “additional police presence” in medical facilities, and deploying “armed, on-duty police officers working as hospital resource officers.” The University of Pennsylvania Medical Center Memorial Hospital in York, where the gunfight took place, suggested it was doing everything right already, proclaiming its existing “armed police officers and security teams are devoted to keeping us safe” without addressing the question so obviously implied. Hospitals—like so much of American society—are already crawling with police. If they keep us safe, why does this keep happening?
There was a time in my medical training when witnessing police activity in healthcare settings still shocked me. First as a medical student and now as a resident physician, the many entanglements between “care and carceralism” have surrounded me for so long that I can readily trace my own awful acclimation to such ambient violence. Early in my education, I once watched aghast as Sherriff’s Deputies at a county hospital angled past a team of nurses tending to a dying man, so they could snap pictures of the bullet wounds that were killing him. In the years since, I’ve encountered police pinning patients to the ground in their hospital rooms, interrogating sick people and their medical teams about protected health information, preventing families from visiting suffering relatives, and arresting injured victims of violence for outstanding warrants. Working in hospitals, I see police every day: outside the main entrance, inside the emergency department, beside the labor and delivery unit, in front of rooms where patients in custody lie shackled to their beds. These militarized state agents roaming the wards can become so normalized, I often have to jar myself out of my own complacency and complicity, asking, with the refreshing urgency of disability rights activist Leroy Moore, “Police in the hospital?! That shit doesn’t make sense at all! . . . How did that become a reality?”
In her pathbreaking work Golden Gulag, the abolitionist geographer Ruth Wilson Gilmore famously called prisons and policing “catchall solutions to social problems,” for how they are deployed by the state in reaction to a seemingly endless range of policy challenges, from interpersonal violence to school absences, with little to no consideration for underlying causes or long-term effects. The reflexive authority of this carceral logic is readily apparent in the rise of policing in healthcare and in the responses of hospitals and politicians to the terrible violence at UPMC Memorial in York. Faced with a problem—which violence in places of healing certainly is—our governing class offers only a singular vision: more cops, cages, guns, surveillance, punishment, confinement, and militarized state violence. This reactionary eruption of course ignores the fact that there is little reason to believe expanding the carceral apparatus will reduce the problems it claims to address and overwhelming evidence that it will make many problems worse, while imposing immense financial and human costs on already disadvantaged groups of people.
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Organized abandonment, a term Gilmore has deployed more recently to describe how the state siphons resources away from certain communities and towards others in response to the self-generated crises of capitalism, provides a useful framework for understanding the rise of carceralism in our decaying healthcare system. Despite costly and ever-expanding police intrusions into medicine, workplace violence remains more common in healthcare than any other industry in America. At the same time, 68,000 people die every year due to lack of access to health insurance, medical debt is the leading cause of bankruptcy in the United States, and a national obsession with profit extraction enabled through consolidation, deregulation, privatization, financialization, and outright corruption in healthcare prevents movement towards even a marginally healthier and less costly social order.
While leaders at all levels of government—Democrat and Republican alike—insist that there is never enough money for desperately needed investments in public health, raises for nurses, or renovations to old hospital wards, they manage to come up with $115 billion dollars a year to spend on the nation’s policing and mass incarceration apparatus. They appropriate, on an emergency basis, nearly $20 billion in public funds in a single year to facilitate a genocide in Palestine that has involved the systematic murder of healthcare workers, while imposing an autocratic austerity regime on health and welfare spending here at home. In the aftermath of the UPMC Memorial shooting, a single York county hospital could find $20 million for increased security measures, yet the governing municipality remains unable to spare even $100,000 for community violence intervention programs.
Emerging from within a system that so thoroughly degrades the value of human life, these deadly tradeoffs present opportunities to reclaim the radical health politics forged by previous generations of revolutionaries. In Body and Soul, the sociologist Alondra Nelson describes how, when leaders of the Black Panther Party mandated in 1970 that every one of its chapters create a People’s Free Medical Clinic, they were responding to the very same tendencies of organized abandonment we are experiencing now, recognizing the transformative power of health in guiding broader change, a step in that liberatory process envisioned by Fred Hampton: “First you have free breakfasts, then you have free medical care, then you have free bus rides, and soon you have FREEDOM!” Similar survival programs launched by other groups in the second half of the twentieth century shared in this spirit. As Johanna Fernandez relates in The Young Lords, when that group of Puerto Rican radicals peacefully occupied the Bronx’s Lincoln Hospital in 1970 to protest appalling conditions there, they simultaneously launched free health care screenings and other welfare programs from within their short-lived encampment.
In our darkening political environment, it is crucial for the abolitionist movement to recognize the deep interdependence of the struggle for health justice and the fight against carceralism. With America’s profit-driven medical system delivering deteriorating and severely racist outcomes at staggering public and personal expense, it is worth considering how healthcare, especially when entangled with the carceral apparatus, can become one of those “death-making institutions” described by the visionary abolitionist Mariame Kaba. As the 1971 Panther announcement of the People’s Free Medical Clinic in Berkeley put it: “We will be subjected to institutionalized genocide whether it comes from inadequate housing, the barrel of a pig’s shotgun, or from inadequate medical attention.” Our violent political economies of both health and carceralism often produce the same devastating effects on those most vulnerable in our society.
While leaders at all levels of government—Democrat and Republican alike—insist that there is never enough money for desperately needed investments in public health, raises for nurses, or renovations to old hospital wards, they manage to come up with $115 billion dollars a year to spend on the nation’s policing and mass incarceration apparatus. They appropriate, on an emergency basis, nearly $20 billion in public funds in a single year to facilitate a genocide in Palestine that has involved the systematic murder of healthcare workers, while imposing an autocratic austerity regime on health and welfare spending here at home. In the aftermath of the UPMC Memorial shooting, a single York county hospital could find $20 million for increased security measures, yet the governing municipality remains unable to spare even $100,000 for community violence intervention programs.
Emerging from within a system that so thoroughly degrades the value of human life, these deadly tradeoffs present opportunities to reclaim the radical health politics forged by previous generations of revolutionaries. In Body and Soul, the sociologist Alondra Nelson describes how, when leaders of the Black Panther Party mandated in 1970 that every one of its chapters create a People’s Free Medical Clinic, they were responding to the very same tendencies of organized abandonment we are experiencing now, recognizing the transformative power of health in guiding broader change, a step in that liberatory process envisioned by Fred Hampton: “First you have free breakfasts, then you have free medical care, then you have free bus rides, and soon you have FREEDOM!” Similar survival programs launched by other groups in the second half of the twentieth century shared in this spirit. As Johanna Fernandez relates in The Young Lords, when that group of Puerto Rican radicals peacefully occupied the Bronx’s Lincoln Hospital in 1970 to protest appalling conditions there, they simultaneously launched free health care screenings and other welfare programs from within their short-lived encampment.
In our darkening political environment, it is crucial for the abolitionist movement to recognize the deep interdependence of the struggle for health justice and the fight against carceralism. With America’s profit-driven medical system delivering deteriorating and severely racist outcomes at staggering public and personal expense, it is worth considering how healthcare, especially when entangled with the carceral apparatus, can become one of those “death-making institutions” described by the visionary abolitionist Mariame Kaba. As the 1971 Panther announcement of the People’s Free Medical Clinic in Berkeley put it: “We will be subjected to institutionalized genocide whether it comes from inadequate housing, the barrel of a pig’s shotgun, or from inadequate medical attention.” Our violent political economies of both health and carceralism often produce the same devastating effects on those most vulnerable in our society.
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Sickle cell anemia testing at the Black Community Survival Conference, March 30, 1972 | Photo by Bob Fitch | Source: Bob Fitch Photography Archive, Stanford Libraries. | Read more on Black Panther Healthcare Liberation Strategies in Alondra Nelson’s Body & Soul.
Despite our governing class’s drumbeat of enthusiasm for using policing and prisons as responses to so many forms of human need, there are signs of a growing awareness in our communities that policing and healing are fundamentally incompatible in a healthy society. Indeed, hints of this lesson were recognizable almost immediately in the aftermath of the York hospital attack in February. As in the rest of the country, violence in healthcare is very often driven by unmet material needs, the deprivations of racialized poverty, and the unhealthy accessibility of deadly weapons in the United States. In the words of one of the physician assistants who cared for the shooter’s dying wife over what appears to have been a harrowing hospital course, “grief, exhaustion, isolation, and a lack of mental health and social support services create cracks that people fall through” in an environment that fails to deliver quality care due to racism, understaffing, moral injury, and profit-driven decision-making. “While people will look for someone to blame, the reality is this: the system is failing all of us.”
The accumulating human carnage of these devastating failures leaves us searching for a path forward. If “freedom is a place,” as Gilmore imagines, this examination must begin with the sobering recognition that “concepts of ‘safety’ and ‘health’ cannot be realized by razor-wire fences or magic-bullet cures.” Operating, as we are, inside a political and cultural landscape suffused with the conviction that a better world is not possible, our first task is to refuse that nihilistic premise at the heart of American carceralism, insisting, at every turn, that we deserve and can create a healthier society. There is no way to know whether long term investments in communities of care, health, education, and other welfare programs would have prevented the hospital shooting in York, and there is of course no excuse for any sort of violence committed against healthcare workers. But, as we are already living in what French sociologist Loïc Wacquant twenty years ago called “the first genuine prison society in history,” we can be sure that more cops and cages won’t succeed in the future where they have already failed so spectacularly in the past.
Every day, we confront anew the constraints of life in that prison society, and our power to build something more caring in its place depends on our ability to imagine its impermanence. The seeds of this radicalism have been germinating for years in health-related abolitionist campaigns around the country. In my hometown of Los Angeles, site of the largest mental health institution in America (the county jail), local organizers have enlisted healthcare workers into a monumentally successful grassroots effort to halt correctional expansion, rallying the community around a powerful call for “care first, jail last.” In Atlanta, healthcare workers have joined the fight against new jail leases as part of a “Communities Over Cages” campaign, which recently blocked construction of a proposed detention center that would have diverted $2 billion from far healthier investments in social services programs. Where I live in the Bay Area, a longstanding effort among healthcare workers aimed at removing the Sherriff’s Department from our public hospitals and clinics is lending its support to community organizers pushing for broader anti-carceral policies in our upcoming local budget cycle, another small example of the generative power of abolitionist coalition-building.
Nurturing this broad movement towards justice in health, what is needed is a corollary of the very premise of medicine itself: a cleareyed acceptance of circumstance paired with the steadfast hope that what is broken might somehow be healed. This will require healthcare workers—particularly those of us with relative power in our outdated labor hierarchies—to relinquish control over the movements we are joining, recognizing that this struggle must be led by patients and communities if it is to have any hope of succeeding. While abolitionists often focus on the prison as the source of so much social ill, a turn away from carceralism also demands training attention on how we can construct new understandings of safety, health, and care in all the places we live and work, not so much for the sake of achieving some ephemeral cure for all that ails our society as for developing new methods to heal, as best we can, the splintered fragments of our own collective suffering today.
Jake Sonnenberg is a resident physician, member of the Committee of Interns and Residents--Service Employees International Union, and organizer with Healthcare Workers for Abolition