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Michigan's In-Cell Restraints Considered Torture; Injunction Issued
by David M. Reutter
A Michigan federal district court has held that the use of in-cell restraints for punitive reasons constitutes torture. In reaching that conclusion, the Court reopened its previous judgment concerning mental health claims and issued a preliminary injunction.
The Court's ruling comes in the Hadix case, a longstanding prison conditions suit dating back to 1980 that involves several prisons operated by the Michigan Department of Corrections (MDOC). In January 2001, the Court terminated enforcement of the mental health provisions of an earlier consent decree. The case has generated dozens of rulings and published opinions.
After the August 6, 2006 death of Timothy Souders, whom the Court identified only as T.S., the Plaintiffs moved to reopen the terminated decree provisions, arguing that Souders'death and the deaths of other prisoners were attributable to delays or malfeasance in the provision of mental health care. [See related article in this issue of PLN, Michigan Prisons: Another Failure in Privatized Prisoner Health Care].
The first two sentences of the Court's order, written by U.S. District Judge Richard A. Enslen, set a somber tone: Say a prayer for T.S. and the others who have passed. Any earthly help comes far too late for them. The Court then detailed the circumstances of Souders' prolonged death in a segregation cell.
Souders, 21, had a history of mental illness. He was placed in segregation for disobedience of custodial orders on August 2, and put in soft standing restraints (locking leather and vinyl restraints around his hands, feet and wrists). An hour later he flooded his sink; he was then placed in four-point top of the bed restraints.
Top of the bed restraints involved the chaining of a prisoner's hands and feet to a concrete slab with four metal, arc-shaped handles emanating from the slab for the purpose of receiving the locking restraints. The Court noted that Souders was naked and lay in his own urine, for hours in this position.
On one occasion, T.S. refused to cooperate with his restraint; this prompted five guards to use a large plexiglass shield and place their weight upon T.S. while they locked him, screaming, to the slab with chains.
Based on doctors' testimony, the Court found that much of Souders' defiant and self-destructive behavior was the product of untreated mental illness, which consisted of bipolar disorder, depression, hyperactivity disorder and suicide attempts.
On August 2, a social worker who saw Souders described him as "floridly psychotic", and ordered him to be transferred to a Crisis Stabilization Program. While the approved referral form was marked "Emergent" a transfer coordinator failed to transmit the order to Souders' prison. The immediate consequence of the failure to transfer was that a psychotic man with apparent 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, the Court noted.
Moreover, Souders was on several medications that required close monitoring, as they could cause dangerous side effects. Several were known to cause dehydration, temperature regulation interference and chemical imbalances. Two of the days that Souders was in four-point restraints were designated as "heat alert" days, with temperatures of around 100 degrees.
At 6:00 a.m. on the day of his death, Souders was assisted to a shower. He was brought back via wheelchair and again placed in top of the bed restraints. Because he slept a lot, he was released from his restraints at 1:00 p.m., but promptly fell face first on the concrete floor. Guards assisted him back onto the slab.
A few minutes later he fell again, but no one checked him for more than an hour. A nurse attempted to check his pulse and/or blood pressure, and answered Souders' inquiry about the readings by saying, "it's faint, but I heard it." No emergency medical help was summoned. An hour later Souders was found dead in his cell. The cause of his "entirely preventable" death was determined to be "dehydration and arrhythmia."
Dr. George Pramstaller, MDOC?s Medical Director, stated, "I think in looking at the tapes in particular it was very apparent in the tapes that T.S. was having number one, mental deterioration, and number two, physical deterioration." Dr. Pramstaller went on to say there was "ample opportunity" for guards and medical personnel to intervene, but "that was not done."
In December 2006 the Joint Reference Committee of the American Psychiatric Association (APA) issued a resource document titled, "The Use of Restraint and Seclusion in Correctional Mental Health Care." Souders' forcible four-point restraint violated every one of the APA's recommended guidelines.
The Court also detailed the facts related to the June 2006 death of a prisoner identified as P.H., who died after refusing treatment for hyperthyroidism because of paranoia. The Court noted that Correctional Medical Services (CMS), the private company that manages MDOC's health care at Hadix prisons, wanted the case managed without the specialist referral recommendation by an endocrinologist who examined P.H. The Court also detailed the cases of prisoners who died from a lack of, or simply did not receive, adequate mental health treatment.
The Court found that many of the MDOC's health care deficiencies could be attributable to insufficient staffing, which included a period in which no psychiatrist was available. Instead, limited license holders provided care -- which was a violation of Michigan law. Between July 7 and September 9, 2006, those limited practitioners operated with no supervising psychiatrist.
During that period, staff were fulfilling rote paperwork requirements in seeing patients, but would not provide actual services except in rare cases. The Court found that such violations were systematic.
Judge Enslen noted he had found it helpful to include a "brief review on the history of torture in the United States" in his ruling. Space limitations prevent that review here, but the Court observed that when the power to punish is granted on lower levels of administrative authority, there is an inherent and natural difficulty in enforcing the limitations of that power. Such a practice also generates hate toward the keepers who punish and toward the system that permits it.
The Court found that the restraints used on Souders "pose a deadly risk to the persons restrained because it subjects those persons to a known unreasonable risk of heart attack, dehydration, and asphyxiation"
Moreover, the use of punitive irons (restraints) are prohibited under the Military Commission Act of 2006 on foreign unlawful combatants and thus should be prohibited when used on other prisoners.
The Court ruled that the use of non-medical, in-cell restraints to punish prisoners constituted torture in violation of the Eighth Amendment. The resulting injunction placed an immediate ban on the use of such restraints except to transport prisoners, to quell riots, or to provide safety. They also may be used to "Prevent self-harm, injury to staff, and interference with treatment" when supervised by medical staff. Further, there must be coordination of treatment between medical and mental health staff.
The Court concluded its order with a stern message to MDOC's medical staff: "You are valuable providers of life-saving services and medicines. You are not coat racks 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, night or weekends, if necessary. If someone in the bureaucracy, including CMS, is stopping you from providing necessary services in a timely way, or stopping the patient from obtaining necessary specialist care or medicine, you should pester the malefactors until they respond and the services are provided. If they still won't relent, you are to relay their names, including correct spellings and addresses at which they may be arrested, to the medical monitor so those persons may be held in contempt and jailed, if necessary. The days of dead wood in the Department of Corrections are over, as are the days of CMS intentionally delaying referrals for craven profit motives."
The Court reopened the mental health consent decree and issued a preliminary injunction. Unfortunately, it took the deaths of several mentally ill prisoners to send a much-needed wake-up call to MDOC and its for-profit health care contractor. Just as unfortunately, the state still hasn't learned -- it has appealed Judge Enslen's order banning the use of punitive restraints. See: Hadix v. Caruso, 461 F.Supp.2d 574 (W.D.Mich., 2006).
Additional sources: APA Resource Document, Dec. 2006; www.wlns.com; Muskegon Chronicle; New York Times; www.mlive.com
A Michigan federal district court has held that the use of in-cell restraints for punitive reasons constitutes torture. In reaching that conclusion, the Court reopened its previous judgment concerning mental health claims and issued a preliminary injunction.
The Court's ruling comes in the Hadix case, a longstanding prison conditions suit dating back to 1980 that involves several prisons operated by the Michigan Department of Corrections (MDOC). In January 2001, the Court terminated enforcement of the mental health provisions of an earlier consent decree. The case has generated dozens of rulings and published opinions.
After the August 6, 2006 death of Timothy Souders, whom the Court identified only as T.S., the Plaintiffs moved to reopen the terminated decree provisions, arguing that Souders'death and the deaths of other prisoners were attributable to delays or malfeasance in the provision of mental health care. [See related article in this issue of PLN, Michigan Prisons: Another Failure in Privatized Prisoner Health Care].
The first two sentences of the Court's order, written by U.S. District Judge Richard A. Enslen, set a somber tone: Say a prayer for T.S. and the others who have passed. Any earthly help comes far too late for them. The Court then detailed the circumstances of Souders' prolonged death in a segregation cell.
Souders, 21, had a history of mental illness. He was placed in segregation for disobedience of custodial orders on August 2, and put in soft standing restraints (locking leather and vinyl restraints around his hands, feet and wrists). An hour later he flooded his sink; he was then placed in four-point top of the bed restraints.
Top of the bed restraints involved the chaining of a prisoner's hands and feet to a concrete slab with four metal, arc-shaped handles emanating from the slab for the purpose of receiving the locking restraints. The Court noted that Souders was naked and lay in his own urine, for hours in this position.
On one occasion, T.S. refused to cooperate with his restraint; this prompted five guards to use a large plexiglass shield and place their weight upon T.S. while they locked him, screaming, to the slab with chains.
Based on doctors' testimony, the Court found that much of Souders' defiant and self-destructive behavior was the product of untreated mental illness, which consisted of bipolar disorder, depression, hyperactivity disorder and suicide attempts.
On August 2, a social worker who saw Souders described him as "floridly psychotic", and ordered him to be transferred to a Crisis Stabilization Program. While the approved referral form was marked "Emergent" a transfer coordinator failed to transmit the order to Souders' prison. The immediate consequence of the failure to transfer was that a psychotic man with apparent 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, the Court noted.
Moreover, Souders was on several medications that required close monitoring, as they could cause dangerous side effects. Several were known to cause dehydration, temperature regulation interference and chemical imbalances. Two of the days that Souders was in four-point restraints were designated as "heat alert" days, with temperatures of around 100 degrees.
At 6:00 a.m. on the day of his death, Souders was assisted to a shower. He was brought back via wheelchair and again placed in top of the bed restraints. Because he slept a lot, he was released from his restraints at 1:00 p.m., but promptly fell face first on the concrete floor. Guards assisted him back onto the slab.
A few minutes later he fell again, but no one checked him for more than an hour. A nurse attempted to check his pulse and/or blood pressure, and answered Souders' inquiry about the readings by saying, "it's faint, but I heard it." No emergency medical help was summoned. An hour later Souders was found dead in his cell. The cause of his "entirely preventable" death was determined to be "dehydration and arrhythmia."
Dr. George Pramstaller, MDOC?s Medical Director, stated, "I think in looking at the tapes in particular it was very apparent in the tapes that T.S. was having number one, mental deterioration, and number two, physical deterioration." Dr. Pramstaller went on to say there was "ample opportunity" for guards and medical personnel to intervene, but "that was not done."
In December 2006 the Joint Reference Committee of the American Psychiatric Association (APA) issued a resource document titled, "The Use of Restraint and Seclusion in Correctional Mental Health Care." Souders' forcible four-point restraint violated every one of the APA's recommended guidelines.
The Court also detailed the facts related to the June 2006 death of a prisoner identified as P.H., who died after refusing treatment for hyperthyroidism because of paranoia. The Court noted that Correctional Medical Services (CMS), the private company that manages MDOC's health care at Hadix prisons, wanted the case managed without the specialist referral recommendation by an endocrinologist who examined P.H. The Court also detailed the cases of prisoners who died from a lack of, or simply did not receive, adequate mental health treatment.
The Court found that many of the MDOC's health care deficiencies could be attributable to insufficient staffing, which included a period in which no psychiatrist was available. Instead, limited license holders provided care -- which was a violation of Michigan law. Between July 7 and September 9, 2006, those limited practitioners operated with no supervising psychiatrist.
During that period, staff were fulfilling rote paperwork requirements in seeing patients, but would not provide actual services except in rare cases. The Court found that such violations were systematic.
Judge Enslen noted he had found it helpful to include a "brief review on the history of torture in the United States" in his ruling. Space limitations prevent that review here, but the Court observed that when the power to punish is granted on lower levels of administrative authority, there is an inherent and natural difficulty in enforcing the limitations of that power. Such a practice also generates hate toward the keepers who punish and toward the system that permits it.
The Court found that the restraints used on Souders "pose a deadly risk to the persons restrained because it subjects those persons to a known unreasonable risk of heart attack, dehydration, and asphyxiation"
Moreover, the use of punitive irons (restraints) are prohibited under the Military Commission Act of 2006 on foreign unlawful combatants and thus should be prohibited when used on other prisoners.
The Court ruled that the use of non-medical, in-cell restraints to punish prisoners constituted torture in violation of the Eighth Amendment. The resulting injunction placed an immediate ban on the use of such restraints except to transport prisoners, to quell riots, or to provide safety. They also may be used to "Prevent self-harm, injury to staff, and interference with treatment" when supervised by medical staff. Further, there must be coordination of treatment between medical and mental health staff.
The Court concluded its order with a stern message to MDOC's medical staff: "You are valuable providers of life-saving services and medicines. You are not coat racks 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, night or weekends, if necessary. If someone in the bureaucracy, including CMS, is stopping you from providing necessary services in a timely way, or stopping the patient from obtaining necessary specialist care or medicine, you should pester the malefactors until they respond and the services are provided. If they still won't relent, you are to relay their names, including correct spellings and addresses at which they may be arrested, to the medical monitor so those persons may be held in contempt and jailed, if necessary. The days of dead wood in the Department of Corrections are over, as are the days of CMS intentionally delaying referrals for craven profit motives."
The Court reopened the mental health consent decree and issued a preliminary injunction. Unfortunately, it took the deaths of several mentally ill prisoners to send a much-needed wake-up call to MDOC and its for-profit health care contractor. Just as unfortunately, the state still hasn't learned -- it has appealed Judge Enslen's order banning the use of punitive restraints. See: Hadix v. Caruso, 461 F.Supp.2d 574 (W.D.Mich., 2006).
Additional sources: APA Resource Document, Dec. 2006; www.wlns.com; Muskegon Chronicle; New York Times; www.mlive.com
