The right to healthcare: A false promise of health in America’s prisons

Last month’s coverage of the conditions at Riker’s Island have people across the country appalled. Dr. Vernier, former physician at Riker’s Island, shared many of his experiences with patients at the prison with NPR, describing the horrific case of Carlos Mercado, who died within 15 hours of arriving at the prison due to complications of his diabetes. He had been denied insulin during the intake process.

Prisoners are the only people in the country with a constitutional right to healthcare, under the 1976 Supreme Court Estelle v. Gamble decision, which held that withholding healthcare from prisoners constituted “cruel and unusual punishment,” prohibited by the Eighth Amendment. But isn’t the case of Carlos Mercado grounds for “cruel and unusual punishment?” The right to healthcare seems to be a false promise at Riker’s, especially when we consider the facility’s history.

Riker’s is notorious for cruelty and inhumane treatment of prisoners. Earlier in de Blasio’s appointment as city mayor, a 2014 report from U.S. attorney Preet Bharara detailed graphic human rights abuses and use of violence against adolescent males placed at Riker’s Island. One such account from 2012 reads:

“…Inmate F, a mentally impaired inmate, was repeatedly punched in the face by an officer who has been involved in well over 20 other RNDC use of force incidents. Although the officer admitted that he delivered multiple blows to the inmate’s face, the Department concluded that the force used was appropriate based on the officer’s contention that he was acting in self-defense… There is no video of the incident…

…Inmate F reported that the officer challenged him to a one-on-one fight… According to DOC records, the officer was involved in a total of 24 use of force incidents… from 2007 through early 2013, including eight incidents in 2012 alone. He also has been subject to repeated disciplinary actions.”

Unfortunately, these human rights violations persist not just at Riker’s, but as an inherent part of the nation’s correctional system. Earlier this year, approximately 1,600 prisoners at the Metropolitan Detention Center in Brooklyn were left with sporadic heating and no lighting over the course of multiple days. Families were left completely in the dark about the fact that their loved ones were suffering in the facility. No generators were powered on to restore lights and heating as detainees pounded on the windows in retaliation to being left to freeze.

There are physical health consequences of being unable to read your medication labels in the dark. However, more latent are the mental health repercussions when prisoners realize they are not just trapped, but that there is nobody to even allow them their basic rights or human dignity. The right to healthcare applies to mental as well as physical health. We need to take a close look at outcomes to truly assess whether the right to healthcare is upheld in prisons or not.

The capacity for cities like New York to harm people through incarceration is vast, and there is a poor track record of tangible benefit coming from imprisonment for those detained nationwide. In 2016, the Avid Prison Project described that solitary confinement routinely exacerbates symptoms for those with mental illness. Moreover, inmates with psychiatric needs are put on waiting lists for hospital treatment much too often, even when hundreds of beds are available. It seems that the right to healthcare is a promise to take two leaps back for every small step forward.

Broken policies that keep the mentally-ill from receiving care in prisons can change. We can start by re-routing those with mental health needs from prisons to programs focused on healing and reintegration for the 42% of inmates at Riker’s Island who suffer from mental illness. Instead of reverting to punishment-based criminal justice, we can transform the lives of those in prison and reduce incarceration rates by expanding proven alternatives to incarceration.

In particular, we should expand New York’s assertive community treatment (ACT) programs for those with mental illness. Programs like Manhattan ACT bring holistic treatment and therapy to those with mental illness who face incarceration due to a felony arrest directly to them in their communities. Manhattan ACT itself has seen a 36% decrease in psychiatric hospitalizations among program participants in Northern Manhattan. In addition to their mental health benefits, ACT programs have also reduced recidivism rates. Nathaniel ACT’s graduates since 2014 have had no violent arrests within one year of graduation and its graduates since 2013 had no new felony convictions within two years. ACT programs turn lives around and are one just solution to the crisis of housing the mentally-ill in federal and state prisons.

The right to healthcare is one of prisoners’ civil rights, protected under the Eighth Amendment to the Constitution. However, if prisoners are delayed necessary treatment and placed in conditions that worsen their health problems, then this right is far from being upheld seriously. With 45% of federal prisoners having mental health or behavioral problems, we need to expand evidence-based alternatives to incarceration like ACT programs and work with our communities instead of against them.

Syed Kaleem is a medical student at Drexel University College of Medicine. He is a fellow of Physicians for Criminal Justice Reform. @ZaneKaleem on Twitter

Waffle House: America’s Best Place To Eat, Not Engage Police

by Drs. Otega Edukuye, Christopher Hoffman, Kevin Simon, and Christopher Smith on behalf of Physicians for Criminal Justice Reform, Inc.

If you have lived in the South, you know Waffle House for its 24-hour table service and meals like the All-Star breakfast served with a waffle, bacon, eggs, toast, and hash browns – scattered, smothered and chunked for under ten bucks. If you lived in this country last year, you also know Waffle House as the place where 22-year-old Anthony Walls and 25-year-old Chikesia Clemons were manhandled by police. Then, tensions were so high that Bernice King, daughter of Martin Luther King, Jr., called for a boycott of Waffle House. [1] While the media coverage has dwindled, we will revisit these situations so that passion for change and resolve does not die when the incidents are no longer headlines.

We empathize with Ms. Clemons and Mr. Anthony and recognize that her experience at Waffle House is representative of a larger dilemma. As Black male physicians, these incidents are a grim reminder that our medical degrees will have little influence on our path to address health disparities as long as the criminal justice system ensnares and oppresses those of the darker skin tone.  As more videos of police exerting excessive force on people of color continue to surface, it is evident that a paradigm shift in law enforcement is necessary.

Many argue that the constant influx of police brutality videos overestimate its occurrences, but the evidence and available literature suggest otherwise. It is estimated that law enforcement officers use measures of force against Black people a staggering 3.6 times higher than when dealing with White people. [2] These differences persist even when controlling for variables such as alleged offense committed and type of force utilized. The study “Deaths of People with Mental Illness during Interactions with Law Enforcement” found that “African American race and presence of mental illness were strongly associated with fatalities.”

Our concern is that while there is compelling data to support that over-use of force against citizens of color is indeed a real issue, there is resistance among law enforcement agencies to adopt tactics that will universally decrease excessive use of force, namely, de-escalation training.

In these videos, we noticed that police rarely attempt to reduce the suspect’s tensions. As fourth-year psychiatry residents, we have been skillfully trained in human behavior and treatment of patients with mental health concerns. We realize that approaching agitated people with demands and hostility rarely, if ever, improve a situation. Each of us has successfully de-escalated many of our agitated patients by simply talking with them; no physical contact or medications. Although conditions for a police officer in a community differ from those we face as doctors on the psychiatry wards, there is ample evidence that increased training in de-escalation could have merit for professionals working to save lives and keep the peace across disciplines.

According to reporter Albert Samaha, “excessive force complaints against the Dallas Police Department dropped by 64% between 2009 and 2014. The number of arrests and officer-involved shootings also declined in recent years.” [3] The changes Dallas Police Chief David Brown implemented emphasized de-escalation. Brown stated, “Rather than running into a situation, take your time approaching a suspect, talk over a strategy with your partner. Have just one officer talking with a suspect — rather than multiple people shouting — try to build a rapport with the suspect.”[4] To us, calm discussion with an agitated individual seems the obvious first step. We perceive this unfathomable opportunity a loss in the fact that nearly 70% of states do not require de-escalation training for police. [5]

With all the videos, data, and protests by those marginalized by the majority, police still maintain permission to overstep justice in their attempt to restore order and make an arrest. The United States was founded nearly 250 years ago, and yet, people of color continue to find themselves treated as second-class citizens. As Black men and physicians backed by Physicians for Criminal Justice Reform, we are advocating for concerted collaborative change within the policing community. While Waffle House employees should receive better training, the positive impact on disenfranchised communities and people of color will be greatest if police training across the U.S. included de-escalation training. As psychiatrists in training, we know that as protracted trauma and mistrust persist, the psychological effects worsen and become intractable. Until we see genuine changes in the way law enforcement engages our communities, tensions between police and Black people will not improve.

 

REFERENCES

  1. Baer, Drake. “The Dallas Police Force Is Evidence That ‘De-Escalation’ Policing Works.” The Cut, 8 July 2016, www.thecut.com/2016/07/deescalation-policing-works.html.
  2. Cognac , Chris. “Ready, Set, Engage! Ideas and Options for Community Engagement and Partnership Building.” COPS, June 2015, cops.usdoj.gov/html/dispatch/06-2015/community_engagement_and_partnership_building.asp.Samaha, Albert. “Dallas Officer-Involved Shootings Have Rapidly Declined In Recent Years.” BuzzFeed, BuzzFeed, 8 July 2016, www.buzzfeed.com/albertsamaha/dallas-police-numbers?utm_term=.ead1DP0L8.
  3. Samaha, Albert. “Dallas Officer-Involved Shootings Have Rapidly Declined In Recent Years.” BuzzFeed, BuzzFeed, 8 July 2016, www.buzzfeed.com/albertsamaha/dallas-police-numbers?utm_term=.ead1DP0L8.
  4. Gilbert, Curtis. “Most States Neglect Ordering Police to Learn De-Escalation Tactics to Avoid Shootings.” What It Takes | APM Reports, 5 May 2017, www.apmreports.org/story/2017/05/05/police-de-escalation-training.
  5. King, Bernice. “Family, Let’s Stay out of @WaffleHouse until the Corporate Office Legitimately and Seriously Commits to 1) Discussion on Racism, 2) Employee Training, and 3) Other Plans to Change; and until They Start to Implement Changes. Https://T.co/NJWFOBKN7i.” Twitter, Twitter, 10 May 2018, twitter.com/BerniceKing/status/994564295374655488.

It’s Time to Treat Our Youth as Youth: The Physicians for Criminal Justice Reform Adopt a Policy Statement in Support of Keeping Youth out of the Adult Criminal Justice System

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It’s Time to Treat Our Youth as Youth:

The Physicians for Criminal Justice Reform Adopt a Policy Statement in Support of Keeping Youth out of the Adult Criminal Justice System

There is a reason why the medical field has pediatricians. It is the same reason why the justice system has juvenile court judges. Kids are fundamentally different from adults. As a result, they should be treated and cared for differently. Yet, nearly 200,000 youth enter the adult criminal justice system every year and 10,000 juveniles are housed in adult prisons and jails on any given day. These statistics take on an even more ominous and urgent meaning when we recognize that youth housed in adult jails are 36 times more likely to commit suicide than youth housed in juvenile detention facilities. As recently as last month, our country loss a 15-year old child in New Orleans to suicide while in an adult jail.

Physicians for Criminal Justice Reform (PfCJR) was founded by a group of physicians who were struck by the myriad of ways contact with the criminal justice system can lead to detrimental health outcomes for youth and adults.

The juvenile justice system like the field of pediatrics is about treating and rehabilitating children, because we know that children are not just “mini adults.” Biologically speaking, the brains of juveniles are still under construction—they do not have the neurological connections that facilitate executive functioning and the ability for complex decision making like adult brains. Yet, in some states, the law allows a child as young as 10 to be tried and treated as an adult, flying in the face of what we know about neurodevelopment.

When we allow youth to be treated as adults in the criminal justice system we are making kids vulnerable to things their minds and bodies are not mature enough to handle. We need a balance between holding youth accountable and acknowledging neurodevelopment and the society’s interest and commitment to rehabilitation.

In order to support this vision, the Board of Physicians for Criminal Justice Reform adopted a statement in October during National Youth Justice Awareness Month supporting the end of the prosecution, sentencing, and incarceration of youth under the age of 18 in the adult criminal justice system.

[Y]outh in adult jails and prisons are more likely to be sexually assaulted, physically assaulted and upon release, are more likely to re-offend than youth housed in juvenile facilities. Each of those experiences, as well as early developmental experiences that put adolescents at risk for involvement with the criminal justice system, result in long-lasting, negative physical and mental health consequences that could be avoided by juvenile justice reform that identifies and diverts at-risk youth. As doctors, it is our duty to make a united stand against environmental factors that affect both the mental and physical health outcomes of our patients. Read the full statement here.

We are proud to stand with the Campaign for Youth Justice and other advocates across the country in saying enough is enough. It is time to use science, data, and our experiential knowledge of youth to stop the treatment of youth as adults in the criminal justice system.

To learn more about Physicians for Criminal Justice Reform visit our website at: https://pfcjreform.org/

You can also join PfCJR as physician, medical student, or friend.

Petition to require that all police officers go through racial bias training

Physicians for Criminal Justice Reform, Inc. (www.pfcjreform.org) is calling for the federal government to require Implicit Racial Bias Training for police departments nationwide as a condition of eligibility for federal grant funding.

PLEASE CLICK HERE TO SIGN THE PETITION.  We need 100,000 signatures in the next 30 days at which time the White House will respond to our request, which means this petition must go viral.  Please help us make that happen.

At least 9 people were killed last week as a result of our policing crisis. CDC data shows that Native Americans, Blacks, and Latinos are killed during police interactions at higher rates than Whites. Perceived criminality and implicit racial bias are significant drivers of this problem.

Research shows that police who are made aware of their implicit biases are motivated and able to implement unbiased policing behavior.

The federal government should immediately require all police departments to implement implicit racial bias training for their officers.

PLEASE CLICK HERE TO SIGN THE PETITION.

PRESS RELEASE: Physicians for Criminal Justice Reform Calls For Implicit Racial Bias Training for Police Officers

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FOR IMMEDIATE RELEASE
PfCJR
July 11, 2016 – Physicians for Criminal Justice Reform, Inc. (PfCJR) which advocates to eliminate the damaging health consequences that can result from negative interactions with the criminal justice system, is calling for the federal government to make funds available to local police departments across the country to provide implicit racial bias testing to their officers, and measure the training’s effect on violent interactions with the public.
In response to the tragic deaths of Alton Sterling, Philando Castile, Brent Thompson, Patrick Zamarripa, Michael Krol, Lorne Ahrens, Michael Smith and Alva Braziel which occurred over the last week, Physicians for Criminal Justice Reform hosted a heavily-attended open conference call to action during which Drs. Edjah Nduom and Nzinga A. Harrison, M.D., Founder and Co-Founder of Physicians for Criminal Justice Reform, unveiled a fourth core issue for the organization:  Reduction of violent encounters between law enforcement professionals and the general public.  
Officer Damion Polite of City of Houston Police Department spoke to the group.  He praised the advocacy efforts of the group and emphasized the similarities between physician work and police work — seeing people during a crisis, wanting to be of service.  He emphasized that police officers also want to see an end to fatal encounters.  He noted that one big difference existed between the two groups — in general, people trust their physicians, while in general, people fear police officers.  He emphasized the community-based programs that City of Houston Police Department have enacted in attempts to integrate with the communities they serve such as the Teen and Police Service Academy (TAPS) and others which can be found on their website.  Officer Polite told the group, he believes that it is those programs that account for a low incident of fatal encounters despite the fact that his department patrols the most violent neighborhoods in the city.  He closed by asking the group to continue to be supportive to police officers for training needs especially related to managing individuals with mental illness and understanding the fear and lack of trust that many have in the police.
Data shows that blacks and native americans are at higher risk of being killed during interactions with police officers than other racial/ethnic groups.  Perceived criminality and implicit racial bias are significant drivers of this problem.
A comprehensive article published in Police Chief Magazine in 2011 notes:
  • Implicit bias is measurable
  • Implicit biases are pervasive
  • People are often unaware of their implicit biases
  • Implicit biases predict behavior
  • Individuals who are made aware of their implicit biases are motivated and able to implement unbiased behaviors

The first initiative of PfCJR’s new taskforce will be the creation of a petition to be delivered to the white house calling for the federal government to make funds available to local police departments for the provision of implicit racial bias testing to police officers and research to study the results of the training.  Members and Fellows of PfCJR will be notified when the petition is available and are encouraged to sign and circulate.  Click here to join PfCJR.

The full recorded video of the Open Conference Call to Action can be watched by clicking here.

Alton Sterling, Philando Castile and Dallas Police Killings: PfCJR Call to Action. Open Conference Call Monday, July 11, 2016 at 9:00PM EST

PfCJR OPEN CONFERENCE CALL MONDAY, JULY 11, 2016 AT 9:00PM EST

  In the last four days, this country has watched a devastating series of tragedies unfold.  We watched police shoot Alton Sterling at point blank range while pinned to the ground.  We watched Philando Castile die after being shot four times by a police officer in front of his fiancée and daughter.  We watched Dallas police officers massacred even as they seeked to protect citizens at a peaceful protest.   All of these have served to underscore the urgency of acting NOW to begin combatting the forces that are driving these events. pfcjr call invite Physicians for Criminal Justice Reform invites you to join us on an open conference call this Monday, July 11, 2016 at 9:00pm EST.  You do not need to be a physician to join either the call or the organization.  We recognize that we need the unified voices of all allies if we are to effect meaningful, lasting change.  Click the graphic above for more details about the call.  If you haven’t already, please join us at www.pfcjreform.org/join so we can keep you informed of updates.   Please spread the message far and wide.  We need as many voices as possible.

Alton Sterling and Philando Castile Killed by Police

Alton Sterling and Philando Castile are dead, joining a long roll call of black people killed by officials acting in the name of public safety. And so the nation now begins a process so familiar as to have become rote.  Read the full article here.

Physicians for Criminal Justice Reform, Inc. (PfCJR) is a group of physicians advocating to eliminate the damaging health consequences that can result from negative interactions with the criminal justice system.  Alton and Philando have suffered the ultimate of damaging health consequences — death.  Our website has been inundated with visits.  Our membership has nearly doubled in the last two days.  Physicians are ready to speak out, and we are ready to lead change.

Please know that even if you are not a physician, we need your voice as an allied supporter.  It is our duty to use our expertise and our passion to effect true, meaningful, lasting criminal justice reform in this country.

You will be hearing from us soon with specific steps for how to get involved.  Go to www.pfcjreform.org/join to stay informed.

 

 

 

Use of isolation in juvenile detention centers

Physicians for Criminal Justice Reform (PfCJR) CORE ISSUE:  Juvenile justice reform to identify and divert at-risk youth.

Isolation in juvenile detention centers persists despite ample data demonstrating the traumatizing consequences to youth who often already have been traumatized.  Dr. Brittany Raffa writes a poignant piece that was published in the December 1, 2015 issue of Family Practice News regarding the practice.  Highlights:

  • Youth are kept in isolation for several days, with a vague definition by staff on the limit of “several days.”
  • While in isolation or segregation – whatever it is called – mental illness and posttraumatic stress disorder are exacerbated. Youth do not participate in school classes, and they are barred from the daily hour of physical activity.
  • The use of isolation in juvenile centers has led to increased suicide rates in those children.
  • More than 50% of all youths’ suicides in juvenile facilities occurred while young people were isolated alone in their rooms, and … more than 60% of young people who committed suicide in custody had a history of being held in isolation.”

Read the entire article at www.familypracticenews.com

Click here to JOIN PfCJR as a physician or allied member as we advocate for criminal justice reform.

For Police, A Playbook for Conflicts Involving Mental Illness

PfCJR CORE ISSUE:  Decriminalization of mental health and addictive disorders. 

As reported by the New York Times online.

PORTLAND, Ore. — The 911 caller had reported a man with a samurai sword, lunging at people on the waterfront.

It was evening, and when the police arrived, they saw the man pacing the beach and called to him. He responded by throwing a rock at the embankment where they stood.

They shouted to him from a sheriff’s boat; he threw another rock. They told him to drop the sword; he said he would kill them. He started to leave the beach, and after warning him, they shot him in the leg with a beanbag gun. He turned back, still carrying the four-foot blade.

In another city — or in Portland itself not that long ago — the next step would almost certainly have been a direct confrontation and, had the man not put down the weapon, the use of lethal force.

But the Portland Police Bureau, prodded in part by the 2012 findings of a Justice Department investigation, has spent years putting in place an intensive training program and protocols for how officers deal with people with mental illness.

Read the entire article.

Click here to JOIN PfCJR as we advocate for criminal justice reform.

Three state juvenile lockups selected to participate in a national project designed to improve conditions

From www.chron.com:

Three state juvenile lockups that have been plagued by training and operational problems as officials struggled to deal with a more violent population of incarcerated youths have been selected to participate in a national project designed to improve conditions.

David Reilly, executive director of the Texas Juvenile Justice Department, announced Monday that the Giddings State School, Evins Regional Juvenile Center in Edinburg and the McLennan County State Juvenile Correctional Facility in Mart will be included in the 18-month program.

Three other agencies across the country will also participate: Florida Department of Juvenile Justice;
Massachusetts Department of Youth Services and StarrVista, Inc. in Wayne County, Michigan.

The project is being overseen by the national Council of Juvenile Correctional Administrators and the Center for Juvenile Justice Reform at Georgetown University.

Reilly said the project at the three Texas lockups will include training and technical assistance to help his agency improve educational and rehabilitation programming, behavioral management and health care, and transition planning to ensure success for youths after they are released from custody.

Read the entire article www.chron.com

Click here to JOIN Physicians for Criminal Justice Reform, Inc. as we advocate for criminal justice reform.