Early one morning in February, a guard knocked on David Mustiga’s cell door on Rikers Island. Soon, the 43-year-old was shackled and put on a bus to Bellevue.
Inmates at Rikers often struggle to receive even the most rudimentary medical care. But Mr. Mustiga and 10 other prisoners underwent elective bariatric surgery at Bellevue, often spending weeks in hospital.
Even under the best conditions, recovery from bariatric surgery is difficult. Trying to recover in prison, where inmates have little control over what they eat or how quickly they eat it, is especially difficult.
Mr Miller said Rikers patients were “screened and evaluated like everyone else” and were held at Bellevue until they were ready to eat the kind of food available at the prison.
Mr. Mustiga, who was later convicted of drug trafficking, weighed more than 300 pounds and suffered from high blood pressure. He had been thrilled months earlier when a staff member at Rikers Medical Clinic first told him about the benefits of bariatric surgery. He said that no one had warned him of the difficulties of recovery during detention.
When Mr. Mustiga boarded the bus to Bellevue, he thought it was for a quick visit to get blood tests in preparation for surgery. Instead, he was admitted to the hospital’s locked prison ward and placed on a liquid diet.
There he met another patient waiting for bariatric surgery, Luis Perez. The men bonded over their difficult diets and banded together to steal leftovers from their neighbors’ hospital trays.
Mr Perez, awaiting trial for drug possession, first underwent surgery. Subsequently, he told Mr Mustiga that the pain was worse than when he had been hit by a car and lost his arm above the elbow.
Mr Mustiga panicked. He said that he had tried to back out of the surgery, but a doctor told him that this was his only chance to undergo the surgery and that if he didn’t follow through, he would be sent back to prison immediately.
Mr Mustiga said he often used the same pressure tactics on his drug clients. “Tell someone it’s the last try and they’ll find the wallet pretty quickly,” Mr. Mustiga said.
He decided to undergo the operation.
After surgery, patients should eat small, protein-rich meals.
At Rikers, Mr. Mustiga traded cigarettes for protein powder. He looked at a Bellevue pamphlet that outlined the dos and don’ts after surgery. He suggested eating nonfat Greek yogurt or drinking eight cups of Crystal Light. Exercise suggestions included trying a Zumba dance class.
Mr Mustiga was not receiving adequate nutrition. He said he lost more than 100 pounds in less than six months, a rate of weight loss that can be dangerous. His hair was falling out in clumps and his medical records show he was receiving iron supplements for anemia.
This summer, Mr. Perez was transferred to Franklin Correctional, a prison near the Canadian border, to serve a four-year sentence.
During a visit in August with two Times reporters, Mr. Perez’s skin was sallow. He said he wasn’t getting enough protein and couldn’t eat without vomiting. He feared the surgery had made him a target in prison, where size matters for protection.
Two months later, Mr. Perez was severely beaten. He said his attackers stole the protein powder he had set aside.