In the past few years an outcry has arisen over the involvement of military and CIA medical professionals and psychologists in torture, including psychologically destructive solitary confinement of “war on terror” detainees at the Guantánamo prison camp. Some critics have even suggested criminal prosecution of the medical staff involved or, at least, revocation of their professional licenses.

In Maine’s prison system, too, prisoners — many of them mentally ill — are kept in isolation for months or years in the state prison’s 132-cell Special Management Unit, its “supermax,” in Warren. Some Maine doctors are now looking closely at the state’s supermax, saying that solitary confinement constitutes torture, and asking if the medical professionals and psychologists involved with the facility are complicit in torture.

“I do believe they should look at the big picture,” says Janis Petzel, of Hallowell, president of the Maine Association of Psychiatric Physicians, talking specifically about doctors who do “peer reviews,” a type of quality review, of Maine’s prisoner psychiatric care. “Twenty years ahead I don’t want to look back and say we were like the Nazi doctors.” When physicians encounter solitary confinement, she says, they “have a duty to speak out.”

In the recent legislative debate over LD 1611, a bill to restrict prison solitary confinement, Petzel and other supporters spoke out — loudly and clearly. She told legislators at the bill’s public hearing that “by international definition” solitary confinement “is a form of torture.” Sheila Comerford, director of the Maine affiliate of the American Psychological Association, which represents psychologists, told the Criminal Justice Committee that “isolation was included in the American Psychological Association definition of torture in 2007. Members are forbidden from taking part in interrogations which included isolation at U.S. military prisons.”

A number of mental-health experts testified about overwhelming medical evidence that extended solitary confinement both creates and worsens mental illness. The Maine Civil Liberties Union, the National Religious Campaign Against Torture, and other groups also called prisoner isolation a form of torture.

The Department of Corrections has a tidy answer to the question of medical-personnel complicity in solitary-confinement torture. “We don’t utilize solitary confinement in Maine,” says Joseph Fitzpatrick, the psychologist who is clinical director of the prison system. While supermax prisoners are kept in isolation cells for 23 to 24 hours a day, with meals delivered through slots in steel doors, they have interaction with staff, so they are not in solitary, he maintains. At LD 1611’s hearing, corrections officials told of several-times-a-week showers, occasional visits by a chaplain (who generally talks with a prisoner through the cell door), and other contacts that break up isolation. Fitzpatrick admits that if solitary confinement did take place, it might be destructive to prisoners.

But Stuart Grassian, a Massachusetts psychiatrist who is one of the country’s leading authorities on the effects of solitary confinement, says such deniers “don’t know what they’re talking about.” The scientific and legal literature, he says, “totally” would find that Maine supermax conditions constitute solitary confinement. Grassian testified in favor of LD 1611 at the hearing, where he was joined by other experts, legal as well as medical, in describing how Maine supermax conditions rank as classic solitary confinement.

According to Fitzpatrick, the state’s two adult prisons — the other is the medium-security Maine Correctional Center in Windham, where there are 22 solitary-confinement cells — have around 20 mental-health employees covering 1,500 prisoners, including a psychiatrist and two psychologists at each facility. Most of the employees work for Correctional Medical Services, a for-profit corporation that has figured in a number of prisoner-abuse scandals across the country.

Repeated requests by the Phoenix to interview psychologist Maureen Rubano, the state prison’s mental-health director — a state employee — have long gone unanswered.

Maine Medical Association Complicity?

Grassian also has a problem with the peer reviewers — teams of doctors from the Maine Medical Association who regularly monitor the medical and psychiatric care provided in the state’s prisons — if they ignore the effects of solitary confinement on prisoners.

Gordon Smith, the lawyer who’s the MMA’s executive vice-president, says that while there’s “no doubt” solitary confinement causes mental illness, he couldn’t recall solitary confinement ever being mentioned as a factor in an MMA-reviewed case of prisoner mental illness, and he reads each confidential review. Smith says his group is “not contracted” to look at the effects of isolation. The doctors who go to the prison and inspect the patient charts at random, he says, may not even know if the patient is kept in solitary. Prison officials admit that the supermax is where many mentally ill prisoners wind up, and that more than half of supermax prisoners are seriously mentally ill.

In a peer review there are usually three doctors on a team who for $100 an hour look at about 30 to 40 charts, Smith says. In recent years teams have examined prison adult psychiatric care and adolescent psychiatric care — the latter at the state’s two juvenile prisons. Reviewers talk with the caregivers and medical director of the prison unit involved, but “in 25 years of peer reviews around the state I don’t recall a single instance where a reviewer asked to speak to a patient,” Smith says, although the contract with Corrections allows this. Smith wouldn’t reveal reviewers’ names. The MMA has been doing prison-care review for 10 years.

Despite what appear to be extremely narrow reviews, the MMA’s $20,000 annual contract with Corrections obligates it to provide “reviews of psychiatric and other medical care at the MDOC facilities to ensure the highest quality of care for the prisoners and residents.” Grassian finds absurd any refusal by medical personnel to acknowledge the effects of isolation on prisoners, particularly on the mentally ill: “You just can’t be a doctor and not look at living conditions.”

By many accounts psychiatric patients often go back and forth between the supermax’s more relaxed 32-cell psychiatric-care “pod,” where some prisoners get considerable time outside their single-person cells, and its regular solitary-confinement cells. “You don’t have to be a genius” to understand what’s going on in this kind of cycle, Grassian says.
Solitary confinement makes the prisoners sick. “It’s ethically so repugnant” for a doctor to ignore the effects of solitary confinement, he adds. Among some Maine doctors, however, a consciousness is dawning that their colleagues may not be seeing the elephant in the room.

Petzel, the Maine Association of Psychiatric Physicians president, notes that “First, do no harm” is a fundamental principle of medicine. “Turning a blind eye to what’s going on is doing harm,” she says.

A doctor who in March stood with Petzel at a press conference in support of LD 1611, Jacob Gerritsen, a retired internist from Camden and a former MMA president, concurs, but emphasizes, “Let’s face it. Before the bill [LD 1611] no one was paying attention” to this issue. “When you’re in the trenches you don’t see these things.”

Petzel, an MMA member, says she is considering introducing a resolution at the MMA’s annual meeting — the next is in September — challenging the way the organization reviews prison medical practices. Gerritsen says he’d support such a resolution, though he suspects a “very uncomfortable” debate would ensue over it. The MMA took a “neither for nor against” stance on LD 1611, Gerritsen says, because of opposition from doctors he describes as conservative.

The chief doctors’ organization in the state, with 2,000 members out of 3,500 active doctors in Maine, the MMA is affiliated with the American Medical Association, which has a strict policy prohibiting physicians from even being present “when torture is used or threatened.”

At LD 1611’s public hearing, Smith, the MMA executive, acknowledged the “grave concern” some physicians have with solitary confinement, but presented his organization’s involvement in peer reviews at the prison as a kind of conflict of interest that prevents it from taking sides on prisoner treatment.

The torture inherent in solitary confinement is one of many supermax-related issues the Corrections Department has recently had to deal with. Former chaplain Stan Moody and others associated with the prison have reported guard and health-worker callousness toward sick or injured prisoners, prisoner beatings, and widespread tolerance of prisoner abuse. Much of the mental-health therapy, they report, occurs infrequently and with the mental-health worker often separated from the prisoner by the cell door, which is a violation of medical ethics since there’s no patient confidentiality.

The state police are investigating two cases in which supermax prisoners died after allegedly receiving inadequate medical care or having care deliberately withheld. Although the MMA’s contract with the department allows it to review such an “adverse event,” Smith says the department has never asked it to do so.

Before the legislature recently adjourned, it passed a watered-down LD 1611, requiring a study of solitary confinement to be undertaken by the department, the state Board of Corrections, and the Criminal Justice Committee. Backers vow to monitor the study and say they will push the next legislature to pass a bill with teeth in it. Governor John Baldacci, an opponent of the original LD 1611, signed the measure on April 15.

This article originally appeared in The Portland Phoenix on April 21, 2010, and is reprinted with permission of the author.