2015, December 30 – Mumia Abu-Jamal’s Legal Fight for Medical Treatment to Stay Alive in Prison

by Rachel Wolkenstein
A remarkable and legally historic evidentiary hearing in Mumia Abu-Jamal v. Kerestes took place over three days in late December 2015 in the U.S. federal district court in Scranton, Pennsylvania. The amended lawsuit filed August 3, 2015 by attorneys Bret Grote of the Abolitionist Law Project and Robert Boyle is an action for damages, injunctive relief and a declaration of the unconstitutional denial of medical treatment to Mumia Abu-Jamal. The immediate question is whether Judge Robert Mariani will grant Mumia a preliminary injunction and rule that the Pennsylvania Department of Corrections (DOC) has been deliberately indifferent to Mumia Abu-Jamal’s medical condition in violation of the Eighth Amendment’s proscription against cruel and unusual punishment and order the DOC to immediately treat Mumia’s active Hepatitis-C with the new antiviral medications.

A brief summary of the legal case

The legal brief filed August 17, 2015 in support of the Motion for Preliminary Injunction succinctly summarizes Mumia’s case:

“Mumia Abu-Jamal is suffering severe and chronic symptoms from untreated, active Hepatitis-C. In the past several months he has experienced diabetic shock, a painful and pruritic [extremely itchy] rash affecting his entire body, edema, skin lesions, anemia, and likely fibrosis of the liver. Scientific advances in the treatment of Hepatitis-C have established a new standard of care that could cure Abu-Jamal of his Hepatitis-C and alleviate the painful symptoms within 8-12 weeks without significant side effects through daily administration of a single pill. DOC defendants, however, are refusing to provide Abu-Jamal with this medically necessary, life-saving treatment.”

In riveting testimony, Mumia’s doctor, Dr. Joseph Harris, fully described how over the past two years these new antiviral drugs (marketed as Salvadi and Harvoni) have “revolutionized” the treatment of Hepatitis-C (HCV) with a 90-95 percent cure rate. Immediate treatment for all those with active Hepatitis-C is now the recommended standard of care by the American Association for the Study of Liver Disease (AASLD) and the Infectious Disease Society of America (IDSA) and is endorsed by the Center for Disease Control (CDC). The World Health Organization added these new medications to its essential medicines list. In curing HCV, the “extra-hepatic” secondary symptoms including fatigue, itchy rashes, arthritis and muscle pain will also be cured. But the cost in the United States is $1000 per pill, making a course of treatment approximately $90,000.

Medicine for profit in capitalist America means there is no equal access, let alone free access, to this new cure. As for other medical care, insurance coverage depends on the scope and cost of the medical insurance itself. While there is growing public outcry over the high costs, neither Medicare nor Medicaid currently pays for this treatment unless the disease has progressed to severe liver damage.

At the close of the intensive evidentiary hearing on December 23 after the testimony of Dr. Harris, two DOC expert specialists, the DOC’s chief medical officer and the SCI Mahanoy chief medical officer, the following was not in dispute:

  • Mumia Abu-Jamal has active chronic Hepatitis-C, stage-two fibrosis with a 63 percent probability of cirrhosis of the liver.
  • Mumia has “anemia of chronic disease.”
  • Mumia’s severe itchy skin rash is not resolved despite months of intensive treatment.
  • Severely itchy skin is often a secondary symptom of HCV.
  • There is no medical reason for Mumia not to be treated with the new antivirals for Hepatitis-C.

The dispute is clearly not a medical or scientific one. It is social, one of cost and, in regard to prisoners, one of peneological purpose. This was the proverbial “elephant in the room” that the DOC witnesses would not directly address. Instead, the DOC tried to explain the difference between “correctional and institutional standards” and “community standards.” The DOC maintains that this is simply a case of doctors with differing opinions of treatment. That argument was exploded by the DOC expert witness on Hepatitis-C treatment, Dr. Jay Cowan, who responded to attorney Robert Boyle’s question, that “yes he would recommend the new antivirals to anyone who had Hepatitis-C who could pay the $90,000 cost.”

The DOC’s new “Interim Hepatitis-C Protocol,” secretly issued on November 12, 2015 does not take any account of the new drugs’ potential to cure Hepatitis-C and stop its deadly progression and alleviate painful and debilitating symptoms suffered by a significant portion of the prison population. Rather this is a protocol to deny this new treatment to Pennsylvania prisoners. According to the testimony of the head of DOC medical services, Dr. Peter Noel, only five out of some 6000 prisoners with active HCV are getting treatment.

The DOC protocol does not allow treatment to be considered until the prisoner is close to death, with severe complications from cirrhosis of the liver. The protocol has a tortuous and Kafkaesque stratification of who should be considered for treatment. There are numerous “reasons” for exclusions from treatment, including misconduct and not following medical regimens. The last hurdle before treatment may be considered by the Hepatitis-C Treatment Committee is an endoscopy that shows the prisoner has “esophageal varices.” This is a condition in which the “blood vessels in the esophagus may leak blood or even rupture, causing life-threatening bleeding.” If there are no “esophageal varices,” the prisoner is set for another endoscopy in “two to three years.” And then, depending, treatment will be considered.

The DOC lawyers and doctors, from the medical specialist “experts” to the head of its medical services, laid bare the reality of medicine for profit in capitalist America and the function of prisons as repressive punitive institutions without a modicum of care for the medical well-being of prisoners. The court evidentiary hearing unfolded with rare public display of the DOC’s mendacity and utter contempt for its own laws and rules: the suppression and then attempt to keep its Hepatitis-C Treatment Protocol “confidential;” submission to court of a false declaration from its chief of DOC health services; and its expert witnesses testimony that withheld information from Mumia’s medical records that contradicted their opinions. In cross-examination Mumia’s lawyers successfully discredited the DOC’s presentation of false or misleading evidence.

At the close of the evidentiary hearing Judge Mariani set January 13, 2016 as the date that all parties would get transcripts of the hearing, and that written briefs were due by both Mumia and the DOC by February 3, 2016. The judge said he would decide as quickly as possible, making this case his priority.

The implications and scope of Mumia’s lawsuit

While this lawsuit is based on the “deliberate indifference” of the DOC to treat Mumia Abu-Jamal specifically, focusing on the horrific history of his medical mistreatment, this case presents an historic testing of all prisoners’ right under the Eighth Amendment to medical treatment—in fact a cure—of the deadly Hepatitis-C virus that infects 13-25 percent of prisoners. The DOC is seeking dismissal of a class action lawsuit brought in federal district court in Philadelphia on behalf of some 10,000 Pennsylvania prisoners, Chimenti v. Department of Corrections.

In the United States there is no constitutional right to medical care, except that under the Eighth Amendment prison officials have an “obligation to provide medical care for those whom it is punishing by incarceration.” Estelle v. Gamble, 429 U.S. 97, 103 (1976). That obligation is determined by a serious medical need and the state’s acts or omissions that indicate a “deliberate indifference” to that need. Case law holds that deprivation of treatment for reason of cost is deliberate indifference under the Eighth Amendment and therefore unconstitutional.

But if “the law” really was “the law” Mumia would have been immediately granted the Hep-C cure. The DOC would have administered the new antiviral medicine to him without the compulsion of a lawsuit—and done the same for the thousands of other prisoners suffering from Hepatitis-C.

Instead, Mumia has been subjected to over a year of medical mistreatment—the state’s latest attempt to silence and kill him. The DOC has resisted and challenged any diagnosis and medical treatment for Mumia’s skin condition and now refuses to treat his active Hepatitis-C. A fellow prisoner, Major Tillery, confronted prison Superintendent John Kerestes, warning him that Mumia might die unless he was hospitalized immediately. For that act of solidarity, Tillery was transferred to another prison and set-up on a false misconduct charge and spent over four months in the “hole.” An international campaign of protest was launched after Mumia’s near-death from diabetic shock demanding medical treatment and Mumia’s release from prison. Without that campaign, including this legal action to save Mumia’s life, the DOC would have not given him any medical care.

We will see what this court decides and how this case proceeds on appeal. Any court decisions in Mumia’s favor, however small, will be challenged by the DOC, and likely the FOP (Fraternal Order of Police), in the appellate courts and in the public arena. At stake is keeping Mumia alive, striking a blow for medical care for prisoners throughout the country, and expanding the campaign in an international struggle for Mumia’s freedom.

Mumia’s court testimony

On the first day of the court hearing, December 18, Mumia testified via videoconference from SCI Mahanoy; his first court testimony since his 1982 trial. As Mumia’s wife, Wadiya Jamal, stated in her December 18 message, “This rotten-ass system has made many attempts on my husband’s life. Mumia is innocent of the murder of police officer Daniel Faulkner on December 9, 1981 and the cops on the scene all knew that. His Hep-C is from the blood transfusions 34 years ago when he survived a cop’s gunshot to his chest through his lungs to his liver.” Blood transfusions prior to 1992 are a major source of HCV because blood was not thoroughly screened untill then.

In an understated manner Mumia described in court the ravages to his body and mind from this year of pain and near death from diabetic shock. All of Mumia’s medical records from the prison and his hospitalizations were admitted into evidence.

Mumia explained the progression of the severe itchy skin condition that began in August 2014 in small patches and spread over most of his body. In the prison infirmary he was first given topical creams but then treated with steroids and had a catastrophic allergic reaction, a swelling of his whole body such that he could barely breathe. He had rapid extreme weight loss dropping from around 260 pounds down to around 180 in a month’s time. He was fatigued; he couldn’t sleep for all the itching; he was driven to scratch himself bloody at night. Without recognizing it himself he was losing coherence and couldn’t concentrate on his work.

Early morning on March 30, 2015 he collapsed in the prison infirmary, was rushed to a hospital and put into the ICU to treat diabetic shock and a glucose level of close to 600. He testified, “On April 2nd, after being in the ICU near death, and back at SCI Mahanoy I was in the infirmary unable to walk one step. I could not lift my arms, I was too weak to pull myself up off the floor.” Mumia’s prison medical records of blood tests taken on March 6, three weeks earlier showed his glucose level had spiked to deadly dangerous 419. This was ignored by the prison doctors.

In April Mumia’s skin condition worsened, with 70 percent of his body covered in thick scales from head to toe, his skin described alternatively as looking like elephant hide, or reptilian, and also with flaking skin and lesions on his legs too numerous to count. In court Mumia was asked to identify photos taken of him during visits on April 9 and April 26, 2015 with his wife Wadiya Jamal (and myself) showing the scabbing on his arms and the side head shot showing his scaling and peeling skin, a lesion over his ear and folds in his neck. Over the DOC’s objection that these photos were “inflammatory and prejudicial,” Judge Mariani admitted the photos into evidence.

Mumia further described that while taking a shower one morning in early May blisters erupted on his lower legs and he was taken to Geisinger Medical Center for five days of intensive treatment of his skin. He was also given a battery of tests to determine if he had various cancers or other diseases that might be the cause of his skin condition. The doctors and nurses said they had never seen anything like this before. Mumia was wrapped like a mummy every four hours with topical steroid creams and Vaseline for days. This was continued when Mumia returned to the infirmary at SCI Mahanoy.

The tests for cancer were negative. Geisinger doctors recommended in the discharge summary that Mumia should have follow-up gastroenterology consultation for Hepatitis-C treatment. Mumia was found to have an “irregular-appearing liver” and anemia of chronic disease.

Since April, Mumia has been housed in the SCI Mahanoy infirmary. Since May he has Vaseline wraps several times a week as well as baths and for the past month phototherapy was added to ameliorate his skin condition. The DOC infectious disease specialist, Dr. Ramon Gadea, examined Mumia and his medical records in September. Mumia specifically asked him if he had reviewed Dr. Harris’ report that Mumia’s skin condition was likely secondary to his Hep-C. Dr. Gadea told Mumia he agreed with that diagnosis and would recommend Mumia be treated for his Hepatitis-C but he thought the prison would refuse because of costs.

On cross-examination DOC counsel Laura Neals tried to establish that Mumia is better now after all the skin treatment. He testified that although his skin condition is better than before, it still itches terribly and he has difficulty sleeping. He was asked by Neals why he had refused a test for Hep-C in 2011, to which he replied, “I never agreed to blood tests while I was on death row, because I didn’t trust the doctors.” It was in January 2012 when Mumia was being transferred from death row into general population that Mumia had an extensive blood work up and he showed positive for the Hep-C virus. On redirect, Mumia’s attorney, Bret Grote asked: “Would you accept Hepatitis-C treatment?” Mumia answered: “Yes, with it I can live; without it I may die.”

Dr. Suzanne Ross, a clinical psychologist and International Representative of International Concerned Family and Friends of Mumia Abu-Jamal and Prof. Johanna Fernandez, of the Campaign to Bring Mumia Home, testified for Mumia providing more detail and emotion on Mumia’s drastic changes in physical appearance, energy and concentration over the past months while suffering from the severe skin condition and aftermath of the diabetic shock and hospitalizations.

Mumia’s doctor, Joseph Harris

Dr. Joseph Harris is a Board Certified Diplomate in Internal Medicine licensed in New York State. He has extensively treated Hep-C and HIV patients and spent a year as a Village Physician with Doctors Without Borders in Valle de Cauca Columbia. He also practiced in Rwanda.

Dr. Harris began serving as a consultant for Mumia’s attorneys in May 2015 and began monthly visits with Mumia in July. Because the DOC would not grant Dr. Harris any entry as a physician, not even to bring in a pen and pad to make notes, Dr. Harris visited with Mumia as a regular visitor in the visiting room. Nonetheless Dr. Harris was able to take a medical history and personally observe Mumia’s skin and portions of his lower extremities.
Dr. Harris testified that he had treated 100 people with active Hepatitis-C over a recent two-year period of time and the 31 people (including himself) for whom he was able to obtain the new antivirals were totally cured within the 12 week course of treatment. In depth and with clarity for laymen, Dr. Harris described the impact of the new antiviral Hepatitis-C drugs and how quickly the standard of care has changed. Just a year ago, the AASLD protocols still had a prioritization subset to its “treat everyone” recommendation. Mumia, he testified, even under last years’ protocol is in the category of most priority treatment needed because of the numerous secondary effects of Hepatitis-C that he is suffering, particularly the painful skin rash and the chronic anemia.

Mumia’s unique and severe skin condition was diagnosed by Dr. Harris as Necrolytic Acral Erythema (NAE) a rare condition that “typically involves a Black patient with a pruititic [itchy] and/or painful rash that has a minimal response to usual treatments. It is a cutaneous [skin] marker of Hepatitis-C.” He testified that Mumia’s skin condition was not simply eczema and/or psoriasis. Mumia had been treated with the “big guns” of dermatological treatment and his skin condition continues. So long as Mumia’s HCV continues to advance, his severe skin condition will come and go. The intensive skin treatments provided by the prison doctors have reduced but not resolved Mumia’s skin rash. He made it abundantly clear to all—treat Mumia’s Hepatitis-C and his skin rash will resolve.

Another critical point of Dr. Harris’ testimony was the medicine and science in determining whether a person has active chronic Hepatitis-C. A simple blood test determines whether the virus is present. The determining issue is whether there is a “viral load.” But the number—high or low—of that viral load is totally irrelevant as to how much liver damage the virus has caused.

The DOC Expert Witnesses

The DOC’s hired gun as their expert on Hepatitis-C was Dr. Jay Cowan, a Diplomate Board Certified Gastroenterologist, president of Correctional Medical Associates, a subsidiary of Corizon, a Tennessee company that provides medical services to prisons in many states and counties, including in New York and Pennsylvania. At the time he testified, Dr. Cowan was completing his tenure as Medical Director of Rikers Island prison. Corizon, as of December 31, 2015 was terminated as the medical provider for Rikers Island after investigation by the New York City Council. According to a report in CounterPunch, “Abu-Jamal Gets Federal Court Hearing Seeking Order to Treat His Hepatitis-C Infection,” by David Lindorff, December 19, 2015:

“During New York City Council hearings into Corizon’s contract with Rikers, which ultimately led to termination of the company’s contract, Cowan was accused of being callous towards the prison deaths attributable to his company’s neglect, incompetence and malpractice, and with being ‘evasive’ in responding to questioning by city councilmembers.”
Unfortunately Judge Mariani stopped Mumia’s attorney Robert Boyle’s cross-examination of Dr. Cowan’s medical oversight of Rikers Island jail and work with Corizon.

Dr. Cowan testified he was retained by the Pennsylvania DOC to sit on its Hepatitis-C Treatment Review Committee, the existence of which was first disclosed by the DOC during the hearing. He was part of the group that on December 17 (the day before the hearing) denied Mumia the Hep-C treatment. Dr. Cowan is an “expert witness,” which means he frequently testified in court proceedings and is expert at not directly answering questions. He spent considerable time testifying on the means to determine how much liver damage a person with HCV has. He simultaneously acknowledged that new American Association for the Study of Liver Diseases (AASLD) and the CDC Hepatitis-C guidelines established a standard of treatment that “everyone should be treated,” while insisting that the “correctional setting guideline” was the “same” as the “community setting,” with one caveat, “risk stratification.” In other words he supported the view that, in the “correctional setting” a prioritization that precluded treatment until someone is close to dying of liver disease. He was not familiar with all the CT scans and sonograms that showed damage and irregularities in Mumia’s liver.

Dr. Cowan disputed Dr. Harris’ diagnosis of NAE and any correlation between Mumia’s skin rash and his Hepatitis-C based in part on his false understanding that Mumia’s skin condition was “completely resolved.” He testified he had no information that the DOC’s infectious disease expert Dr. Gadea had recommended Hep-C treatment for Mumia on the basis that his skin rash might be secondary to his HCV.

Nonetheless Dr. Jay Cowan, the DOC Hepatitis-C expert was compelled to acknowledge that Mumia has Stage Two liver disease, with “significant probability of fibrosis.”

Dr. Schleicher, the DOC Board Certified Dermatologist, works for an outside medical contractor. He examined Mumia solely via “tele-med,” a form of video conferencing. Questioned by DOC counsel, Dr. Schleicher diagnosed Mumia’s skin condition as a “cross between psoriasis and eczema” with an unlikely connection to Mumia’s Hep-C. But on cross-examination he admitted he knew little about Hep-C, and stated he was unaware that Geisinger Medical Center recommended Hepatitis-C follow-up and treatment for Mumia in May 2015. Additionally Dr. Schleicher testified that he, like Dr. Cowan, was not aware that the infectious disease specialist hired by the DOC, Dr. Ramon Gadea, stated there might be a correlation between Mumia’s skin rash and his Hep-C.

The DOC had suppressed its new protocol for Hepatitis-C treatment–
and then wanted Mumia’s attorneys to agree to confidentiality

John Steinhart, R.N., the SCI Mahanoy Chief Medical Health Administrator, whose job description is to provide the medical oversight of prisoners in that institution, testified that he had no medical responsibility for Mumia’s care. Nonetheless it was Mr. Steinhart who was the DOC witness to first testify that Mumia was being treated and monitored in something called the “Liver Disease Chronic Care Clinic,” an entity previously unknown to Mumia, Mumia’s lawyers or Dr. Harris.

And it was John Steinhart who first testified to the existence of the new DOC Protocol for Hepatitis-C Treatment, issued in November. From the outset of this lawsuit Mumia and his lawyers had been told there was no existing DOC protocol, and hadn’t been for the past two years since the suspension of the prior means of treating Hepatitis-C with interferon. This issue of whether the DOC had treatment guidelines is “only” a core of the entire lawsuit—whether under the DOC’s Protocol Mumia would be treated for his active Hepatitis-C and if not, what was the DOC process for making that determination.

Moreover, the DOC at first argued against this Protocol being introduced into evidence as an open court record. They wanted Mumia and his attorneys to agree to keep the Protocol “confidential.” A specific reason for the secrecy was to prevent the lawyers representing the class action on behalf of all Pennsylvania prisoners with HCV from obtaining a copy.

This was not agreed to and the next day the Protocol was introduced into evidence and became a public document. Prison Radio made a request for the release of the Protocol under the Right to Know Law and that legal office made it clear the Protocol was not a confidential document.

The last act of the DOC—the false sworn declaration of Dr. Peter Noel

The DOC’s position in this lawsuit is medically and morally unconscionable. It is no surprise then that the DOC engaged in repeated misconduct in court beginning with presenting expert medical witnesses who professed lack of knowledge about key parts of Mumia’s medical record—records that contradicted or undermined their “expert opinions.” The withholding, attempting to suppress, and keep secret the new Hepatitis-C Treatment Protocol was yet more evidence of the DOC’s unscrupulousness.

And then came the testimony of Dr. Paul Noel, a Board Certified Family Practice doctor who is the DOC Chief of Clinical Services, the person who is in charge of the DOC medical services. He was the DOC’s last witness for the hearing. His importance to the DOC case cannot be understated. Among other responsibilities, Dr. Noel coordinated with outside medical providers and generally worked to insure that the prison doctors followed specialists’ instructions. He held forth about Mumia’s extensive medical treatment under DOC care, his knowledge of the new AALDS guidelines to treat chronic Hep-C patients and his work on the new DOC Protocol, taking into account the guidelines developed by the Federal Bureau of Prisons as well as the Veterans Administration.

Dr. Noel estimated that of those Pennsylvania prisoners who are positive for the Hep-C virus, some 6-7000 likely have chronic Hepatitis-C and will be eventually evaluated under the new Protocol. He went through platelet counts and other factors the DOC will use to measure the seriousness of liver disease, using a test called the Halt-C to determine the onset of end stage liver disease.

Dr. Noel testified that Mumia’s Halt-C score is 63 percent, greater than the 60 percent level set by the DOC as the breakpoint of cirrhosis of the liver. However, Dr. Noel testified that the DOC treatment review committee determined that based on other factors, Mumia would not be considered for treatment.

Robert Boyle cross-examined Dr. Noel challenging the basis in which the DOC committee determined whether those with chronic Hep-C in general and Mumia in particular would or would not get the new antiviral medicines. When Boyle asked Dr. Noel to identify his sworn declaration, filed in opposition to Mumia’s Motion for a Preliminary Injunction, Dr. Noel immediately recoiled and testified that the signature on the document was his signature but it was NOT his statement.

The next minutes in the courtroom were unusual to say the least. DOC counsel, Laura Neal proceeded to “explain,” asserting that the false statement in the declaration submitted in Dr. Noel’s name was not really important and that Dr. Noel had OK’d it after a likely “clerical error” left a false paragraph being included in a sworn document filed in court. Judge Mariani cautioned Laura Neal to stop, advising her that she was at risk of impeaching her own witness.

Under further cross-examination by Robert Boyle, Dr. Noel testified that the declaration as submitted with his signature wrongly claims that a measure of the severity of liver disease is the viral load number. That is not medically or scientifically correct and Dr. Noel testified he had instructed that paragraph of his declaration be changed before submission to court. But it wasn’t. Moreover, as attorney Bret Grote brought forward, Laura Neal cited this misrepresentation of the measure of liver damage in Dr. Noel’s declaration as medical evidence in opposing Mumia’s motion for a preliminary injunction. The U.S. Magistrate then denied the motion citing this falsehood as one of the medical reasons to deny Mumia treatment. The case then went to Judge Mariani who proceeded to re-consider the motion and hold this evidentiary hearing.

In further cross-examination, Dr. Noel admitted that there were substantive errors in other parts of his declaration, including that Mumia had a normal ultrasound, which was not correct and falsely stating that the infectious disease specialist, Dr. Ramon Gadea had ruled out Hepatitis-C as a cause of Mumia’s skin rash.

DOC’s position of keeping prisoners from “running to court”

To conclude this legal report it is useful to recall the legal argument that took place before the evidentiary hearing began, which the DOC will likely pursue as an appeal issue. The DOC demanded the judge dismiss the lawsuit claiming that Mumia had not completed the prison grievance and appeals process because he hadn’t specifically asked for Hep-C treatment. In legal parlance this is “exhaustion of administrative remedies.” In response to the judge’s questions about putting “form over substance,” Laura Neal, a lawyer for the DOC insisted this was a “matter of principle”…”discouraging inmates from running into court.”

After an hour of legal argument and a two-hour break in proceedings for the judge to review the case law and facts he returned to court and read his ruling upholding the decision to go forward with the evidentiary hearing. In a legally and factually detailed ruling, Judge Mariani said, “in May of 2015 [the DOC had] all the information at [their] fingertips in terms of his health issues.” Judge Mariani ruled that it would have been impossible for Mumia to cite Hepatitis-C, as he had not yet received a proper diagnosis to determine his Hepatitis-C was the cause of his conditions. Judge Mariani told the DOC, “That’s a tortured view of what is required of an inmate in a grievance.”

We need a full mobilization to fight for Mumia’s life and his freedom

This was a “good day in court.” And Mumia has not had many of these. But just as Mumia wouldn’t have gotten into court on this case without international protest and publicity, medical treatment to keep Mumia alive and for those other thousands suffering from Hepatitis-C won’t be won relying on the courthouse or the state legislatures. While fighting hard in the courts, there can be no illusion in obtaining justice there. The state, its cops, its prisons are intent on silencing Mumia and what we are dealing with now is state execution by medical mistreatment. The state won’t stop; the only way Mumia will survive is if he is freed. It will take a broad international campaign that calls for agitation, publicity and demonstrations building the broadest possible support demanding Mumia’s freedom as a central demand. In addition to town hall meetings, we need to obtain the concrete support of more organizations and build on the critical and successful work that’s been done so far to get resolutions from trade union organizations, such as the largest union in the UK, UNITE, San Francisco Labor Council, New York Metro Local 10 for the American Postal Workers Union, the United Steelworkers Union Local 8751 in Boston.

A postscript to acknowledge and thank all those who wrote reports on the hearing or whose public statements I have borrowed from. Although I was there in its entirety, writing a report like this is difficult without a transcript or having the use of a tape recorder. Any errors made are of course my own. —Rachel Wolkenstein