The daily life of inmates at Rikers Island are mostly obscure to the public. But a new book is shedding some light on one part of this sprawling jail system: the difficulties physicians face when trying to provide healthcare to inmates.

In his book,Life and Death in Rikers Island, Dr. Homer Venters writes about what he saw during his tenure as the head of the city's Correctional Health Services. Dr. Venters was in charge of health care facilities at Rikers from 2008 to 2017, and he believes that some of the deaths that occurred in city jails during this time were the result of conditions inmates are subjected to in jail.

Although the city says it’s closing Rikers, there were still around 9,000 inmates being held at the facility as of 2017. We recently spoke with Dr. Venters about his book and the unhealthy state of NYC’s jail system.

One of the first points you make in your book is about truth and transparency. You write that correctional health providers "work in settings that are designed and operated to keep the truth hidden." How so?

Well, I think the doctors, nurses, social workers who care for patients that are incarcerated do so behind closed walls. They do so in this city on a penal colony. It's an island, it's away from the city and so the bridge to Rikers Island might as well be 100 miles long because so much of what happens to our patients and the care we provide is hidden from the outside world.

Your book lays out some of the institutional practices that made it difficult for you to care for inmates in Rikers. For example, improperly recording injuries and illnesses. What other examples of systemic issues come to mind?

I think that the health staff face a really crushing and corrosive force called dual loyalty which is that we think that our loyalty is to our patients, we're going to take care of the people in front of us, but the security services and the way jails work, puts a lot of pressure on our ability to do so. So one of the practices that's ongoing today is having health staff clear people for punishment and solitary confinement. It's unethical but it happens in almost every jail in the country and it really degrades our ability to care for patients and they ability to trust us.

What's the relationship between the health care providers and the correction officers?

In the best scenarios and some of the new mental health units, we work as a team, not only to promote their custodial and security concerns but also care for patients. In the worst situations such as when we don't respond to abuse or neglect or in solitary confinement clearance, we're actually working at cross purposes.

You also write about how inmates were unwilling to report abuse within the jail because of their fear of retaliation from guards. How did that realization come about for you?

For me when I saw patients, I would see patients that reported injuries, that the mechanism that they reported was inconsistent with the type of injuries. So somebody who said they slipped and fell on the toilet that had a jaw fracture. And when I would talk to them and evaluate their injuries, it became clear to me that we had a real problem with patients who have been told already, before they sought care, that if they told the truth they would either face further violence or other forms of retaliation.

In her review of your book, Jennifer Gonnerman of The New Yorker says 112 people died in New York City jails between 2010 and 2016. What can you tell us about the causes of those deaths? How many could have been prevented?

One of the things that every jail should report is not just how many people die but how many of those deaths are attributable to the jail itself. Some years it might have been 20 percent or 10 percent of the deaths were preventable or attributable to the jail but some years it was much higher and so every jail, all 3,000 jails around the country, should be reporting these statistics and also accountable for what went wrong.

And do you think this is just something in New York City or is this nationwide?

These are problems nationwide. We have most of the incarcerations, 12 million a year in this country, happening in county jails. And many of the deaths that occur in these places are both hidden and preventable.

The city is in the process of closing Rikers and constructing new borough-based jails that will take on smaller prisoner populations. Do you think this approach will help decrease health risks for prisoners?

Yes, it's very important. Certainly keeping people out of jail is the surest way to save them from the health risks of jail but closing Rikers is absolutely essential also to addressing some of these issues with brutality, dual loyalty and really the inability to provide evidence based care, ethical care in a crumbling jail system that is far away on a penal colony.

For more, listen to Richard Hake's interview with Dr. Venters on WNYC:

Andy Mai is a temporary assistant producer for WNYC. You can follow him on Twitter here.