Blinded By Fear: Why Americans Continue to Fail at Criminal Justice Reform

Blinded By Fear: Why Americans Continue to Fail at Criminal Justice Reform

Christopher Hoffman, MD

Following the deaths of 15 inmates last month, the failures of the Mississippi state justice system have become the most recent motivator for prison reform. According to Joseph Neff and Alysia Santo from the Marshall Project, the problems with Mississippi prisons include corrupt, underpaid staff, a poor guard to inmate ratio, powerful gangs, and frequent lockdowns. Of course, such cases of inhumane prison conditions are not exclusive to Mississippi. Recall — in 2019, video footage of a Brooklyn prison surfaced, revealing inmates beating on the windows to attract attention; they were out of lights, heat, and warm showers for an entire week in the middle of winter. Later in the same year, several prisons in Alabama were declared unconstitutional for violating the 8th amendment condemning “cruel and unusual punishment,” after investigators uncovered the routine occurrence of sexual assault and excessive violence toward inmates. These cases are not outliers; if anything, they speak to how negligence and lack of transparency are not only widespread problems that pervade the country, but also a structural issue that plagues the incarceration system at large. As medical professionals, it is imperative to promote the reform and reconstruction of the correctional system.

It is no secret that our prison system is in total ruin. Experts use adjectives like overcrowded, understaffed, violent, unsanitary, and even unconstitutional when reporting about our correctional facilities. In addition, prisons are expensive and do not deliver the promised results of rehabilitating inmates to eventually reintegrate into safer communities. According to an article from the Vara Institute of Justice, incarceration does little to alter crime rates, and instead diverts attention from the more effective and less costly ways to reduce and prevent crime. The fact that we spend nearly $24,000 more on inmate retention than education in the public-school system speaks volumes to our country’s priorities. Moreover, most of the money spent on these inmates go toward advancing punishment methods, even though many studies conducted by other countries like Norway have consistently shown that rehabilitation is the most efficient method for crime reduction. With such a defective system, Americans should reflect seriously on why so many of us are unconcerned about our prison system, and how acceptable it is that we have not yet demanded its complete overhaul.

The Maya Angelou quote, “when you know better, you do better,” comes to mind. We possess too much evidence to claim that we are unaware of the gravity of the problems in our justice system. And yet, despite this knowledge, we are still not doing better. Therefore, we must consider another variable unmentioned in the quote. That is emotion. Imagine this — a person comes to your home, tells you he or she was recently released from prison and asks for work. What are you feeling? Although the person has done nothing wrong, the feeling that you are experiencing is probably in the realm of fear — fear that this person is a criminal, doubt that he or she has learned to be “good” from their punishment, concern that his or her behavior has not truly changed, and anxiety that you might be the next victim. These are all valid reasons to be afraid.

However, criminal behavior is explained by far more than the mere notion that past actions predict future ones (i.e., once a criminal, always a criminal). A more realistic and humane understanding should recognize the fact that people who enter prison are not allowed to learn more adaptive ways of living, since punishment is the primary approach to corrections. Studies show that punishment is the least effective method for learning and changing behavior. It takes rehabilitation.

Twenty years ago, Norway’s “revolving door to prison” was much like that of the U.S., with a recidivism rate of about 60-70 percent. This rate decreased after focusing more on the humane treatment of inmates. They built prison facilities that look like dorms or apartments, and trained guards to be more helpful, like counselors. They treat inmates like students, providing education and counseling in a healthy environment to address the circumstances that landed them in prison. Now, their recidivism rate is down to about 20 percent. The Norwegian system is the model for restructuring our correctional system.

Unfortunately, we as a society have bought into the fear-based logic that confinement and punishment improve our collective safety and criminals cycle through prison because they cannot amount to anything else. We allow our fears to overshadow credible data and examples of more effective, less expensive correctional systems. We must gain the courage to trust the facts. As Albert Einstein said, “The definition of insanity is doing the same thing over and over again, but expecting different results.” Let’s do better. Let’s try something different.

Christopher Hoffman is a board-certified psychiatrist and an active member of Physicians for Criminal Justice Reform. He strives to provide excellent care to individuals with mental disturbances, their families, and surrounding communities while creating greater awareness regarding insufficient services to poor and underserved communities.

Legalization: The Necessary Path Forward

Legalization: The Necessary Path Forward

Josh Pagano, D.O.

How do Joe Biden and Cory Booker differ on their policy stances on marijuana decriminalization and legalization? Which is the better policy?

Legalization of marijuana has become a major issue in the Democratic primary, inspiring the now-viral moment in which Cory Booker quipped at Joe Biden, “I thought you might have been high” when Biden announced he did not support the legalization of marijuana.

The criminalization of mental illness and addictive disorders is the major stressor affecting many stigmatized patients. Incarcerated people with substance use disorders are disproportionately poor and African American. As if suffering from addictive disorders were not difficult enough, the ramifications of resulting arrests are also debilitating. The immediate effects include job loss and homelessness, and the intermediate effects include all of the psychological consequences of incarceration — the trauma of physical violence, the fear for one’s safety, and the pressure to join gangs. Individuals leave prison having missed large portions of their family lives, with resulting damage to meaningful relationships. All of these effects compound with the long-term consequence of a criminal record that significantly limits the ability to acquire jobs or housing, and ultimately increases the risk of future violence and recidivism.

Of all illicit drugs, the one resulting in the most arrests is marijuana. Democratic candidates, Joe Biden and Cory Booker, propose different policies regarding how to address the legal status of marijuana. 

Joe Biden supports the decriminalization of the personal use of small amounts of marijuana, claiming that “The punishment should fit the crime, but I think legalization is a mistake.” Instead, he would prefer to reclassify marijuana from a Schedule I Controlled Substance (where it currently resides with Heroin and LSD) to a Schedule II Controlled Substance (listed alongside Dilaudid®, Percocet®, and Fentanyl). However, the unlawful possession of a Schedule II Controlled Substance is a misdemeanor or a felony depending on local state laws, implying that such a re-classification would likely not affect the rates of marijuana-related arrests. It is unclear how Biden will square this with his stance that marijuana should be decriminalized. 

As a point of comparison, alcohol was not always legal. The prohibition of alcohol between 1920 and 1933 initially reduced alcohol use and alcohol-related harm, but these benefits diminished over time as a black market developed to meet consumer demands. A review of arrest records indicates that prohibition had an immediate effect but no long-term impact on public intoxication. Moreover, Harvard University historian, Lisa McGirr, points out that prohibition had unduly adverse effects on African Americans, immigrants, and those with lower socioeconomic status. Law enforcement disproportionately policed these communities. Much like the war on drugs.  

Conversely, it was the legalization and regulation of alcohol, not its decriminalization, that helped America prosper. After the repeal of prohibition, the U.S. reduced criminal violence costs and accumulated billions from tax dollars, which were often earmarked for education, healthcare, addiction treatment, and prevention programs. What’s more, taxes reduce alcohol consumption, as they would similarly limit marijuana use. 

Cory Booker seeks to legalize marijuana and remove it from the Controlled Substances Act entirely. Booker has said, “It’s not enough to simply decriminalize marijuana. We must also repair the damage caused by reinvesting in those communities that have been most harmed by the War on Drugs. And we must expunge the records of those who have served their time. The end we seek is not just legalization, it’s justice.”

While those opposed to legalization argue that it would lead to increases in cannabis-related medical harms (e.g. pulmonary disease and psychosis), mere decriminalization also carries its own costs. Cannabis smokers will still primarily acquire their marijuana from unregulated and often violent drug cartels. Neighborhoods will still live in fear. Young people will still join gangs. Communities of color will still be over-represented in drug arrests. Only legalization will directly address these factors.

Upon legalization, preemptive policies can be implemented to mitigate the anticipated increase in marijuana use. With proper taxes, age restrictions, and prevention programs, society can reap the benefits of lower crime rates and less undue incarceration. To be sure, there is a cost to every solution, including legalization. However, decriminalizing marijuana will not decriminalize mental illness, and ignoring the societal cost of mass incarceration is more than we can continue to bear.  

Unfortunately, the issues of marijuana legalization and criminal justice reform were excluded from the Democratic Debates in December. As we approach the first primary votes, we can only hope that the American people will notice these omissions and take the initiative to continue this conversation. In Senator Booker’s absence, it will be up to the remaining candidates to pick up the torch and light the way toward reforming our criminal justice system.

Joshua Pagano, D.O. is a member of Physicians for Criminal Justice Reform. He is a forensic psychiatrist who specializes in competence to stand trial evaluations and the treatment of severe mental illness.

Write an Op-Ed for PfCJR for Our February Newsletter

Write an Op-Ed


In the recent protests, military and police officers have been using rubber bullets, tear gas, and other forms of force against peaceful protestors.


What are the short-term and long-term health impacts of rubber bullets and tear gas? What repercussions might this have on public health at large?


  • Writer must be a paid member of PfCJR
  • Remain under 750 words
  • Answer this month’s question
  • Share your perspective on the topic
  • Due by January 19, 2020

Submit Piece

        » Send here



The Guardian: “The nationwide anti-police brutality protests sparked by the killing of George Floyd in the US have been marked by widespread incidents of police violence, including punching, kicking, gassing, pepper-spraying and driving vehicles at often peaceful protesters in states across the country. The actions have left thousands of protesters in jail and injured many others, leaving some with life-threatening injuries.”



The Lantern: “The city of Columbus is reviewing the death of an Ohio State graduate who died after being exposed to chemical agents while attending protests in downtown Columbus, Ohio. The city of Columbus is looking into possible connections with Columbus protests and Grossman’s death, according to a tweet from the city Wednesday. The city also said the Columbus Fire Department does not have a record of emergency medical services transporting her to any area hospitals.”



Not sure how to write an op-ed?

Check out this op-ed training webinar! It provides tips for writing effective and engaging op-eds, specifically with regard to health care and physicians issues.

This webinar was co-hosted by one of our partners, Doctors For America, and Families USA.

Click here to watch the webinar.

Have any other questions? Reach us at our social media or the email contact listed below.

A Conversation With The President of the American Medical Student Association

PfCJR Interviews Isaiah Cochran, the National President of AMSA

Recently, Physicians for Criminal Justice Reform announced a collaboration with the American Medical Student Association, where a series of Op-eds and studies are being conducted on various topics such as Juvenile Health Legislation, and Mental Health in the Criminal Justice System. We interviewed Isaiah Cochran, to get some more insight on the collaboration. 

Isaiah A. Cochran, M.D. is national president and chair of the board of trustees for the American Medical Student Association (AMSA). He serves as a key organizational spokesperson for AMSA and active promoter of the organization’s educational programming, advocacy pursuits and membership recruitment and engagement efforts. In addition to serving as an AMSA board member since 2016, Cochran also has held leadership positions with Refugee Student Alliance and Global Health Initiative. He earned his medical degree from the Wright State University Boonshoft School of Medicine in Dayton, Ohio, and a bachelor’s degree from Waynesburg University, Waynesburg, Pa.

Why are you interested in criminal justice reform?

I am interested in CJ reform, due to the fact that there are many people who are being imprisoned and they should not be. We are also seeing minorities charged for crimes at a higher rate than non-minorities and this is not ok.  I stand by justice for everything in life, and CJ reform is no exception to my rule for paying it forward. When it comes to health care, there are far too many individuals who are not being taken care of in prison or people who are being kept in prison longer than they should be all the while not receiving proper care.

What are the goals of the partnership between PfCJR and AMSA?

Our goal is to provide awareness, educate the medical community, mobilize them, fight for change, and vote for those who support reforming the CJ system

Why does this partnership make sense?

It makes sense because we have physicians-in-training who are working with fully licensed docs who also believe in change. This is a powerful combination

What is the importance of the intersections between criminal justice reform and healthcare?

I addressed this a little in the first question. To be succinct, as physicians and physicians-in-training- we have vowed to do no harm. The goal is to maintain the health of those who have been imprisoned so that they can work to better themselves and become citizens who can feel comfortable and society and become productive members of the community. 

What specific project are you currently working on with pfcjr?

I just completed outlines for students to use about the elderly in prison and those who have a mental illness in prison. These were made so that students could feel comfortable enough to go out to their representatives and speak about how reform should happen.

Is there anything else you would like to share about this initiative?

Yes, our goal is to go state by state and get all of the medical community involved in this fight. If we all band together, then we can certainly make a change.

Open Leadership Positions

Open Leadership Positions

  • Physicians for Criminal Justice Reform is seeking physicians to fill open leadership positions on our team. Available positions include:
  • Finance Committee Chair
  • Partner Organization Liaison
  • Local Community Organizer
For Medical Students:
  • Finance Committee Assistant
  • Research Committee Assistant
  • Membership Committee Assistant
  • Local Organizing Assistant
For anyone, including undergraduates:
  • Leadership Intern

All positions:

  • Offer the opportunity to work with an engaged leadership team and established physician-activists on the most critical civil rights issue of our time
  • Are unpaid volunteer positions
  • Require a minimum commitment of 1 year

Want to apply for a position?


Taskforce Directors/Assistant Directors:

  • Work with the Membership Committee to recruit members and fellows to the Taskforce
  • Work with the Research Committee to generate at least one white paper per quarter from their Taskforce 
  • Identify 3 experts within their Taskforce to become members of the PfCJR Speakers Bureau (see more) 
  • Identify 3 experts within their Taskforce to become members of the PfCJR Writers Bureau (see more) 
  • Provide the Public Relations Committee with links to Speakers Bureau events, Op-Eds, announcements of new partnerships, relevant content for posting across media platforms
  • Identify and engage at least 1 new partner organization and partner liaison in the first year, and maintaining those relationships thereafter
  • Report status/progress of the Taskforce at each Board Meeting 
  • Implement other initiatives that advocate reform on the assigned Core Issue as appropriate

Committee Chairs

  • Become a member either of the Speakers Bureau or Writers Bureau
  • Engage committee members each month by providing Taskforce Updates for the PfCJR monthly newsletter 
  • Hold committee meetings no less than quarterly to update and report progress on initiatives 
  • Provide the Social Media Committee with links to relevant content for posting across media platforms
  • Contribute a Committee Update to the Quarterly PfCJR Newsletter
  • Report status/progress of the Committee at each Board Meeting 
  • Implement other initiatives that advocate reform on Core Issues as appropriate 

TaskForce/Committee Descriptions

Finance Committee

The Finance Committee, chaired by the PfCJR Treasurer, is responsible for managing and monitoring the fiscal activities of PfCJR including accounting for revenues and expenditures, developing an annual budget, providing monthly budget reports to the Board of Directors, filing taxes annually and ensuring compliance with all laws and regulations for 501c3 organizations.

Research Committee

The Research Committee is responsible for identifying and centralizing research related to PfCJR’s Core Issues by disseminating findings to the PfCJR membership and public, and supporting Taskforces and Partner Liaisons with literature searches and white papers on Core Issues.

Archive of Past Op-Ed Topics

January 2020


Joe Biden vs. Cory Booker on criminal justice reform and decriminalization of marijuana


Why is decriminalization of marijuana an important issue in criminal reform? How do Biden and Booker’s different platforms address this issue?

BOOKER: Argues Joe Biden was ‘architect’ of criminal justice system

Politico: “Sen. Cory Booker on Tuesday blamed Joe Biden for what he called a “failed” criminal justice system, dismissing the former vice president’s new plan to combat mass incarceration and escalating a weeks-long dispute between the pair.” Booker argues that his plan is more “comprehensive” and capable of creating “transformative change.”


BIDEN: Scrutinized for Crime Bill, Unveils Plan to Reduce Mass Incarceration

New York Times: “Joseph R. Biden Jr., whose long record on criminal justice matters has cast a shadow over the early months of his presidential campaign, has unveiled a comprehensive plan aimed at combating mass incarceration and reducing “racial, gender and income-based disparities in the system.” 


February 2020


The Second Look Amendment Act: a proposed bill which expands eligibility for sentence review to all those who committed crimes before age 25 and have served at least 15 years in prison.


Would the Second Look Amendment Act help or harm the criminal justice system? If passed, what effects would the bill have on public health and juvenile justice?

JAMES FORMAN JR: Justice Sometimes Needs A Do-Over

The Washington Post: Forman Jr. argues that the Second Look Amendment Act “offers a promising corrective to the harsh — and ineffective — practices once commonplace in courthouses across America. The bill gives the D.C. Council a chance to restore a measure of fairness to a criminal system often lacking it. If the council is willing to embrace reason over fearmongering, I am confident the Second Look Amendment Act will be recognized as another proud accomplishment.”


THE POST: D.C. Has Gone Too Far on Justice Reforms

The Washington Post: The Post argues that the Second Look Act would be harmful to the criminal justice system. “Out the window would go transparency and truth in sentencing — the assurance to victims and the community that punishment is what it appears to be. By discouraging judges from considering the original crime when they weigh reducing sentences, the council is putting the public at increased risk, unnecessarily.”


Not sure how to write an op-ed?

Check out this op-ed training webinar! It provides tips for writing effective and engaging op-eds, specifically with regard to health care and physicians issues.

This webinar was co-hosted by one of our partners, Doctors For America, and Families USA.

Click here to watch the webinar.

Have any other questions? Reach us at our social media or the email contact listed below.

A New Partnership for PfCJR

PfCJR Partners With A New Criminal Justice Taskforce From ACOEM

In 2016, the United States held 2.2 million people in prisons and jails, and about 870,000 of these inmates performed some type of work, whether supporting the functioning of the prison, for prison industries, or under contract for private corporations.


They work jobs with well characterized occupational hazards – agriculture, manufacturing, fire fighting, chemical production, and many others – yet our standard occupational health surveillance systems (eg OSHA and NIOSH) explicitly ignore work-related injuries, illnesses, or fatalities in this “institutionalized” population.


Furthermore, there are precisely zero articles in our medical and public health literature addressing the occupational health of prisoners, and prison inmates are almost completely excluded from every major labor and employment protection in the US.

 Finally, inmates are exposed to all the unique hazards of the prison environment – psychosocial stressors, physical and social isolation, poor institutional oversight, and vulnerability to exploitation, powerfully suggesting that these workers suffer higher rates of injury and illness compared to counterparts in the free market.


Herein lies the opportunity – physicians have precisely the training and authority to guide research and address hazards in prisoners’ workplaces. That research must document current injury and illness rates and advocate workplace controls equivalent to those in the free labor market. We must also characterize unique hazards faced by inmates, informed by social epidemiological and qualitative methods, while recognizing the larger environmental forces shaping their overall safety. 


The following article is the first to ever recognize the position inmates hold as the most marginalized of occupational populations, written by a member of the Incarcerated Workers Occupational Health Task Force, under the American College of Occupational and Environmental Medicine (ACOEM). OEM physicians are certified by the American Board of Preventive Medicine and specially trained to attend to the health of workers through epidemiological investigation, direct medical care, prevention of occupational injuries and illnesses, and protection from environmental hazards.


This task force will be applying precisely these skills to address the workplace health of incarcerated workers. In the coming years we will confirm a literature review, scope and plan a research strategy, identify stakeholders, and publish the initial results from our investigations, but a challenge of this magnitude will require broader expertise.


The Task Force is seeking partners from all other medical specialties to help. Virchow reminds us that “It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation,” but together we can build this research from the ground up, propose policy, and to lend the powerful, trusted, and moral voices of physicians to a critical and growing conversation about criminal justice reform. 


Andre Montoya-Barthelemy MD MPH

    Incarcerated Workers Occupational Health Task Force

    American College of Occupational and Environmental Medicine


Andre Montoya-Barthelemy is a physician of Occupational and Environmental Medicine (OEM) in Minneapolis, Minnesota. He is a recent graduate of the HealthPartners OEM residency where he completed his thesis on the labor rights of incarcerated workers, and now serving as clinical faculty, assistant residency director, and consultant medical director for Xcel Energy and General Mills. He intends to continue searching for ways for physicians to combine their unique skills and voice to address topics of human rights.

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.



  1. Baer, Drake. “The Dallas Police Force Is Evidence That ‘De-Escalation’ Policing Works.” The Cut, 8 July 2016,
  2. Cognac , Chris. “Ready, Set, Engage! Ideas and Options for Community Engagement and Partnership Building.” COPS, June 2015,, Albert. “Dallas Officer-Involved Shootings Have Rapidly Declined In Recent Years.” BuzzFeed, BuzzFeed, 8 July 2016,
  3. Samaha, Albert. “Dallas Officer-Involved Shootings Have Rapidly Declined In Recent Years.” BuzzFeed, BuzzFeed, 8 July 2016,
  4. Gilbert, Curtis. “Most States Neglect Ordering Police to Learn De-Escalation Tactics to Avoid Shootings.” What It Takes | APM Reports, 5 May 2017,
  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://” Twitter, Twitter, 10 May 2018,

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


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:

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