Torture in American Prisons
One offshoot of our two million-strong prison population is that prisons, which necessarily assume the responsibility for providing adequate medical and psychiatric care, have an increasing number of services to provide to an increasing number of people. Sadly, the prison indutsry has often proved ill-equipped for the task, for in correctional institutions across the country those services are not being sufficiently provided and in some cases are being outright abrogated.
Take the Hadix facilities operated by the Michigan Department of Corrections. Just last week, in response to the ACLU's National Prison Project's request for a preliminary injunction following numerous inmates' deaths due to delays or malfeasance in the provision of mental health care at Hadix facilities, the United States District Court of Western Michigan (Judge Richard Alan Enslen) issued a powerful (and powerfully-worded) decision on behalf of the rights of American prisoners to be free from cruel and unusual treatment.
The case centered around the death of "T.S.", a 21-year-old male with a history of mental illness. After disobeying custodial orders, T.S. was eventually placed in "top of the bed restraints", where his hands and feet were chained to a concrete slab. T.S. continued to exhibit self-destructive behavior due to his mental illness, and for many hours of the restraint was naked and lying in his own urine in a hot and humid prison in which the outside temperature was 100 degrees. A social worker assessed him on August 2, 2006, reported that he was "floridly psychotic", and referred him to a prison psychiatric hospital. Despite growing signs of deterioration, T.S. was not transferred that day. As the Court observed, "the immediate consequence of the failure to transfer was that a psychotic man with delusions and screaming incoherently was left in chains on a concrete bed over an extended period of time with no effective access to medical or psychiatric care and with custody staff telling him that he would be kept in four point restraints until he was cooperative."
T.S. was prescribed numerous medications, all of which caused serious side effects if not closely and regularly monitored, including kidney failure, dehydration, electrolyte imbalance, depression, and temperature imbalance. On August 6, 2006, four days after the social worker's assessment, and still in being kept in restraints, T.S. was so weakened that he needed a wheelchair to be transported to the shower and back. After prolonged sleeping, he was removed from the restraints. After falling face first onto the concrete floor, he was placed back on the slab. Soon after, he fell off the toilet and was on the floor for half an hour. A nurse took his pulse and said it was faint. No emergency care was summoned. An hour later T.S. was not breathing, and soon after was finally taken to a hospital and pronounced dead. The cause of death was dehydration and arrhythmia (abnormal heart rhythms), which doctors said were entirely preventable had timely medical and psychiatric care been provided.
As the Court noted, neither custody staff nor psychological and nursing staff took any action to summon emergency care despite the obvious need given T.S.'s state of decline. T.S. was just one of a slew of similar fatal cases at the Hadix facility. The Court, guided by the Eighth Amendment of our Constitution prohibiting cruel and unusual punishment, said the case confronted the issue of "when punitive treatment in prison crosses the bloody line of torture".
In ruling that mechanical in-cell restraints as a disciplinary method and/or control mechanism by officers at the Michigan Hadix facilities constituted torture and hence violated the Eighth Amendment, the court wrote that the
"deadly risk to persons restrained... of heart attack, dehydration, and asphyxiation... can no longer be overcome by medical monitoring because correctional physicians now recognize that punitive restraints are a form of torture which cannot be ethically facilitated... Its cessation is required immediately to prevent further loss of life, loss of dignity and damage to both inmates and correctional officers."
The Court delineated permissible uses of such restraints, such as temporary emergency reasons or to prevent harm to medical staff, but prohibited their use for disciplinary purposes. Moreover, the Court required the prison to develop a plan fostering coordination of care between the correctional, medical, and mental health disciplines and ordered the prison to require staff to attend trainings to redress its widespread indifference to patient care.
As the Court told to the prison: "Here is the basic message: You are valuable providers of life-saving services and medicines. You are not coatracks who collect government paychecks while your work is taken to the sexton for burial. If a patient does not receive necessary medical or psychological services, including medicines and specialty care, it is not his problem, it is your problem, a problem that must be solved at lunch, nights, or weekends, if necessary." The Court concludes by blessing T.S. and others who died while under prison "care", and stated that "there lives were short, but their legacies may be long."
As our prison population, which is equal to or greater than the population of 18 individual states, and roughly the same size as the populations of Vermont, Wyoming, North Dakota, and Alaska combined, continues to grow, the demands of providing appropriate mental and physical prisoner care will likewise rise. As humane and unapologetic as Judge Enslen's decision is, it is only one, pertinent to only one complex of correctional facilities, and yet inadequate psychological and medical treatment is a pervasive problem in the United States, from jails at Rikers Island in New York to federal penitentiaries in the Midwest. Perhaps Judge Enslen's words will echo throughout America's endless maze of cells and corridors; if not, unfortunately, we will likely need many more decisions like his, decisions that always come too late for prisoners like T.S.