Eyal Press, Madness: In Florida prisons, mentally ill inmates have been tortured, driven to suicide, and killed by guards. The New Yorker, 2 May 2016. Eyal Press won the “June [2016] Sidney Award for exposing horrific abuses of mentally ill prisoners in the Transitional Care Unit of the Dade Correctional Institution (DCI) in Florida for the New Yorker. Press’ reporting showed that TCU inmates were routinely subjected to physical and sexual abuse at the hands of prison guards. Several prisoners were scalded with steaming water from a hose. One such treatment proved fatal, burning the inmate so badly that the skin peeled off his corpse at the slightest touch. Psychiatrists and technicians who tried to report the abuses also faced retaliation from the guards. After questioning restrictive policies, one psychiatric technician was repeatedly abandoned by guards to face dangerous patients alone. ‘The result was pervasive, lethal abuse: inmates beaten, tortured and killed, sometimes directly in front of health care professionals, who then pretended they saw nothing,’ said Press in an interview for Hillman’s Backstory feature. ‘Much of what takes place in jails and prisons is veiled from scrutiny, which makes abuse and corruption more likely.'”
Shortly after Harriet Krzykowski began working at the Dade Correctional Institution, in Florida, an inmate whispered to her, “You know they starve us, right?” It was the fall of 2010, and Krzykowski, a psychiatric technician, had been hired by Dade, which is forty miles south of Miami, to help prisoners with clinical behavioral problems follow their treatment plans. The inmate was housed in Dade’s mental-health ward, the Transitional Care Unit, a cluster of buildings connected by breezeways and equipped with one-way mirrors and surveillance cameras. “I thought, Oh, this guy must be paranoid or schizophrenic,” she said recently. Moreover, she’d been warned during her training that prisoners routinely made false accusations against guards. Then she heard an inmate in another wing of the T.C.U. complain that meal trays often arrived at his cell without food. After noticing that several prisoners were alarmingly thin, she decided to discuss the matter with Dr. Cristina Perez, who oversaw the inpatient unit….
The field of correctional psychology can attract idealists who tend to see all prisoners as society’s victims and who distrust anyone wearing a security badge—corrections officers call such people “hug-a-thugs.” But Krzykowski, who had not worked at a prison before, believed that corrections officers performed a difficult job that merited respect. And she assumed that the prison management did not tolerate any form of abusive behavior….
When Krzykowski told her [Perez] that she’d heard “guys aren’t getting fed,” Perez did not seem especially concerned. “You can’t trust what inmates say,” she responded. Krzykowski noted that complaints were coming from disparate wings of the T.C.U. This was not unusual, Perez said, since inmates often devised innovative methods to “kite” messages across the facility.
Krzykowski mentioned that she had overheard security guards heckling prisoners. One officer had told an inmate, “Go ahead and kill yourself—no one will miss you.” Again, Perez seemed unfazed. “It’s just words,” she said. Then, as Krzykowski recalls it, Perez leaned forward and gave her some advice: “You have to remember that we have to have a good working relationship with security.”…
In theory, the T.C.U. was designed to provide mentally ill inmates with a safe environment in which they would receive treatment that might allow them to return to the main compound. Krzykowski discovered, however, that many inmates were locked up in single-person cells. Solitary confinement was supposed to be reserved for prisoners who had committed serious disciplinary infractions. In forced isolation, inmates often deteriorated rapidly. As Krzykowski put it, “So many guys would be mobile and interactive when they first came to the T.C.U., and then a few months later they would be sleeping in their cells in their own waste.”…
Insuring that inmates with mental illnesses receive psychiatric care is a constitutional obligation, according to Estelle v. Gamble, a 1976 case in which the Supreme Court held that “deliberate indifference to serious medical needs of prisoners” amounted to cruel and unusual punishment.
Around the same time [1975], the Court ruled, in O’Connor v. Donaldson, that a Florida man named Kenneth Donaldson had been kept against his will in a state psychiatric hospital for nearly fifteen years. The ruling added momentum to a nationwide campaign to “deinstitutionalize” the mentally ill. Activists decried the existence of mental hospitals that were filled, as one account put it, with “naked humans herded like cattle.” During the next two decades, states across the country shut down such facilities, both to save money and to appease advocates pushing for reform. But instead of funding more humane modes of treatment—such as community mental-health centers that could help patients live independently—many states left the mentally ill to their own devices. Often, highly unstable people ended up on the streets, abusing drugs and committing crimes, which led them into the prison system.
By the nineties, prisons had become America’s dominant mental-health institutions. The situation is particularly extreme in Florida, which spends less money per capita on mental health than any state except Idaho. Meanwhile, between 1996 and 2014, the number of Florida prisoners with mental disabilities grew by a hundred and fifty-three per cent.
The Supreme Court failed to clarify how psychiatric care could be provided in an environment where the paramount concern is security. According to medical ethicists, prison counsellors and psychologists often feel a “dual loyalty”—a tension between the impulse to defer to corrections officers and the duty to care for inmates. Because guards provide crucial protection to staff, it can be risky to disagree with them. But, if mental-health professionals coöperate too closely with security officials, they can become complicit in practices that harm patients….
[Florida] State law mandated that prisons offer inmates twenty hours of activities a week, and when [Krzykowski] was hired she was told that she would be responsible for insuring that this happened in the T.C.U. But every time she proposed an activity—yoga, music therapy—her superiors rejected it. Invariably, the reason cited was that it posed a “security risk,” even though the activities were meant to alleviate aggression….
“I kept getting the message that whatever security says goes,” she said.
Krzykowski had heard enough stories about inmates assaulting prison staff to know how dangerous it was to work without protection. One day in the rec yard, after a guard left her alone, an inmate sidled up to her and put his hands on her backside. The inmate was tall and imposing, and had been diagnosed as psychotic. Krzykowski thought of screaming for help, but she sensed that the guard who had vanished would not come rushing back if she did. Instead, she froze. After a moment, she hurried away without looking back. The inmate didn’t follow her. For days afterward, she was shaken. “He definitely could have overpowered me,” she said. “I could have been assaulted, raped–anything.”
Krzykowski’s concerns kept mounting. In her view, the T.C.U. was unacceptably run-down: the walls were mildewed, the hallways were caked in grime, and the sewage system was often backed up. In the staff break room, cockroaches had overrun the kitchen area, infesting even the microwave. Oddly, the water from the kitchen faucet was scalding, so Krzykowski began using it to make ramen noodles for lunch.
One Saturday in June, 2012, Krzykowski was finishing a shift when she heard that an inmate in the T.C.U. named Darren Rainey had defecated in his cell and was refusing to clean it up. He was fifty years old, and, as Krzykowski recalls it, he gave people unnerving looks, “like he was trying to see inside you.” He had been convicted of possession of cocaine, and suffered from severe schizophrenia.
“What’s going on with Rainey?” Krzykowski asked a guard.
“Oh, don’t worry, we’ll put him in the shower,” he told her.
Krzykowski remembers hearing this and feeling reassured. “I was thinking, O.K., lots of times people feel good after a shower, so maybe he will calm down. A nice, gentle shower with warm water.”
The next day, Krzykowski learned from some nurses that a couple of guards had indeed escorted Rainey to the shower at about eight the previous night. But he hadn’t made it back to his cell. He had collapsed while the water was running. At 10:07 P.M., he was pronounced dead.
Krzykowski assumed that he must have had a heart attack or somehow committed suicide. But the nurses said that Rainey had been locked in a stall whose water supply was delivered through a hose controlled by the guards. The water was a hundred and eighty degrees, hot enough to brew a cup of tea—or, as it soon occurred to Krzykowski, to cook a bowl of ramen noodles. (Someone had apparently tampered with the T.C.U.’s water heater.) It was later revealed that Rainey had burns on more than ninety per cent of his body, and that his skin fell off at the touch.
Krzykowski said to the nurses that, surely, there would be a criminal investigation.
“No,” one of them told her. “They’re gonna cover this up.”
In the days after Rainey’s death, Krzykowski learned from several inmates in the T.C.U. that Rainey was not the first person who had been locked in that shower; he was only the first to die there. Before this, she would have rolled her eyes had someone told her that the guards tortured inmates. She now asked herself how she could have been so blind. Nevertheless, Krzykowski did not file a report calling for the guards who killed Rainey to be held accountable—and no one else on the mental-health staff did, either….
In January, 2013, one of Krzykowski’s new patients, a convicted burglar named Harold Hempstead, told her that he had information about Darren Rainey’s murder. Hempstead, a wiry man with hazel eyes, occupied a cell that was directly below the shower where Rainey was tortured. That night, he heard Rainey screaming repeatedly, “Please take me out! I can’t take it anymore!” He also heard him kick at the stall door. Eventually, there was a heavy thud, followed by the voices of guards calling for medical help. A short while later, Hempstead watched as a gurney with Rainey’s naked body on it was wheeled past his cell.
Hempstead kept a diary, and in it he had recorded the names of four other inmates who had been subjected to what he called the “shower treatment.” He had even noted the dimensions of the stall, surmising that an inmate locked inside it would likely have just enough room to avoid getting sprayed directly by the scalding water but not enough to prevent it from lapping at his feet. The stall had little ventilation, so steam built up. After nearly two hours in the shower, the steam caused Rainey to lose consciousness.
In the weeks after Rainey’s death, Hempstead told several mental-health counsellors in the T.C.U. that he felt haunted by what he had heard and seen. They warned him that if he told them too much they would have to write an incident report, which would be forwarded to security officials, exposing him—and, by implication, them—to retaliation….
But Hempstead, who had been given a diagnosis of obsessive-compulsive disorder, wouldn’t let the matter drop. He told Krzykowski that he had begun filing grievances about Rainey’s murder….
On May 17, 2014, Julie Brown, of the Miami Herald, published an article in the paper about the abuse of mentally ill inmates in the T.C.U. at Dade. Below the headline was a photograph of Darren Rainey, dressed in prison blues. Brown’s main source was Hempstead, who had turned over copies of the complaints that Krzykowski had encouraged him to write. The article indicated that Hempstead, after being interviewed, had been threatened with solitary confinement and other forms of punishment by three corrections officers.
After the Herald article appeared, Jerry Cummings, the warden, was placed on administrative leave, and many people questioned whether the Department of Corrections had tried to cover up a case of lethal abuse. Far less attention was paid to why an inmate had exposed it, rather than one of the prison’s mental-health or medical professionals. The duty to protect patients from harm is a core principle of medical ethics. According to the National Commission on Correctional Health Care, an offshoot of the American Medical Association which issues standards of care for prisons, any mental-health professional who is aware of abuse is obligated “to report this activity to the appropriate authorities.”…
In May, 2015, Jamie Fellner, a senior adviser at Human Rights Watch, released a report documenting the use of force in U.S. prisons against inmates with mental disabilities. The report, titled “Callous and Cruel,” offers a grim account of tools that are routinely used to incapacitate and punish the estimated three hundred and sixty thousand prisoners with serious mental illnesses: full-body restraints, chemical sprays, stun guns, extended solitary confinement. “Mental-health staff in prisons all too often acquiesce,” Fellner told me. “There is this culture of ‘It’s none of our business’ . . . which means that nobody ends up advocating for the patient.”
Kenneth Appelbaum, a psychiatrist who spent nearly a decade as the mental-health director of the Massachusetts Department of Corrections, agrees that deference to guards is common. He also faults professional organizations such as the American Psychiatric Association for paying little attention to the ethical challenges facing their members who work in prisons….
By the time [17 May 2014] the Herald article on Darren Rainey’s death appeared, Krzykowski was no longer working at Dade…. When I met Krzykowski, in March, 2015,… [s]he recalled, “There was one particular night I couldn’t sleep because I was crying too hard, thinking, Oh, my God, all this time has gone by and I didn’t say anything, even when I was out of the situation. I let it continue. These guys are still suffering. They’re still there. Why didn’t I do more?”…
Sometime later [after March 2015], I met Harold Hempstead, Krzykowski’s former patient, at the Columbia Correctional Institution, in Lake City, Florida. He had been transferred there in 2014, after his sister, Windy, convinced officials at Dade that his life would be in danger if he remained there. We spoke for an hour in a featureless gray room while a sergeant stood watch. Hempstead said that after Rainey’s murder several mental-health counsellors urged him to stop “obsessing” over the crime. One told him that he was being “delusional”; another cautioned him to keep any accusations “vague.” Hempstead acknowledged the pressure that mental-health counsellors in the T.C.U. were under. “Their hands were tied,” he said. But too many of them had internalized the view that the inmates in the unit deserved rough treatment. If more counsellors had been willing to stand up for the prisoners, he said, “the majority of that stuff wouldn’t have happened.”…
In September, 2014, Disability Rights Florida, an advocacy organization, filed a lawsuit charging the Florida Department of Corrections with subjecting mentally ill inmates at Dade to “abuse and discrimination on a systematic and regular basis.” According to the terms of a settlement reached last year, the Department of Corrections agreed to make several changes, including the installation of a new camera system at Dade, better training of guards, and the hiring of an assistant warden of mental health.
One morning this past September, I drove to Dade to meet the new assistant warden, Glenn Morris….
I asked Morris if the desire to appease security might affect how well mental-health counsellors did their jobs. “Dr. Perez, I’m sure, tells her staff to report things to her,” he said. “And I’m very confident that if she found out something she would report it to us.” I said that I had heard otherwise. Morris rolled his eyes, telling me that he assumed my understanding came from a “disgruntled” ex-employee—meaning George Mallinckrodt. I said that other former employees had the same misgivings. “Obviously, that was way before my time,” he said.
Morris came across as well-intentioned, but his assurance that inmates were getting their “basic needs” met was disputed by a source who spoke to me confidentially. Prisoners, I was told, still came to the inpatient unit of the T.C.U. and languished after being placed in what amounted to solitary confinement. Many prisoners received no treatment at all. In one case that was described to me, a young inmate afflicted with paranoia had been degenerating for more than a year. Though he was not disruptive, he had spent prolonged periods in lockdown, because he had stopped taking his medication. Nobody had encouraged him to try different medication; nobody had tried to engage him in activities that might have lessened his feelings of distrust. As a result, the source said, the patient was “undergoing a quiet decompensation where he just gets sicker and sicker.”
The mental-health staff continued to defer to security, acquiescing when inmates were disciplined for misconduct that was clearly related to their illnesses. An inmate with diagnosed impulse-control problems had his privileges taken away after an outburst. Mental-health officials checked a box indicating that the inmate’s issues had played no role.
Bob Greifinger, a professor at the John Jay College of Criminal Justice who studies mental-health conditions in prisons, told me that routine neglect is no less pernicious than flagrant abuse….
The civil-rights division of the Justice Department has launched an investigation to determine whether the death of Darren Rainey is part of a broader pattern of abuse….
Before I left Missouri, Krzykowski told me that she wanted to take me to a place called the Glore Psychiatric Museum, in St. Joseph. The museum, which occupies a drab brick building, offers an unsettling commentary on how people with mental disabilities have been treated in the past. We walked through a series of rooms filled with arcane devices—a fever cabinet, a lobotomy table. At one point, we stood before a full-scale replica of a nineteenth-century cell at the hospital of Salpêtrière, in Paris. Michel Foucault wrote about the hospital in his 1961 book, “Madness and Civilization,” and he called the era it represented “the Great Confinement.” Krzykowski peered into the cell, a dingy chamber littered with straw, and read the label on the wall:
At the hospital of Salpêtrière the insane were kept in narrow filthy cells. . . . When frostbite resulted, as it often did, no medical help was available. Food was a ration of bread once a day, sometimes supplemented by thin gruel. The greatest indignity was the chains.
Afterward, we sat in a gazebo outside. “We don’t learn very fast,” she said.
Additional resources:
Julie K. Brown, Cruel and Unusual: Deadly abuse in Florida’s prisons. Miami Herald, 17 May 2014-21 March 2015. “One inmate suffering from mental illness was locked in a scalding-hot shower for two hours until he collapsed and died. Another prisoner was gassed to death in a concrete cell while begging for medical assistance. A third allegedly tied a double knot and hanged herself while her hands were cuffed. “Cruel and Unusual” is a…Miami Herald investigation into what prisoners, their loved ones, lawyers and activists say is a culture of brutality and a pattern of cover-ups in one of the nation’s largest prison systems.”