McPherson is the state's only women's prison. Built to house roughly 600 prisoners, it held approximately 700 at the time of the investigation. Grimes housed young men from 16-24 years of age. The units are part of a single complex. Both are comprised of barracks-style dormitories (which have been found unconstitutional as far back as 1970).
Originally operated by Wackenhut Corrections Corporation, the state resumed control of the prisons in July 2001 after refusing to pay for increased operating costsbut the problems persist.
Medical care at the prisons, which is provided by Correctional Medical Services (CMS), was found to be seriously deficient.
For instance, asthmatics' access to chronic care was impeded by a CMS policy prohibiting medical personnel from ordering inhalers, instead requiring the prisoners to report to the infirmary when they experienced breathing problems. However, prisoners reported that the guards who controlled access to the infirmary routinely denied them admittancea practice investigators determined could result in avoidable fatalities.
Hepatitis C treatment was not provided at either prison due to "fiscal efficacy," according to medical staff. Although cost-effectiveness is a legitimate factor, the report noted, treatment decisions must "be based on thorough medical assessments" as well.
Acute care was a major problem at the McPherson women's prison. Arkansas Department of Corrections (ADC) and CMS policy requires prisoners to be seen within 24 hours of submitting a sick call request (SCR). Medical staff admitted the 24 hour requirement was rarely met, but insisted that most prisoners were seen within 72 hours. The investigation determined, however, that "virtually no one" was seen within 72 hours, and found instances of prisoners waiting as long as 2 or 3 weeks. Moreover, some prisoners actually received disciplinary reports because their symptoms disappeared before being seen.
Acute care was further limited by McPherson's sick call hours11:00 p.m. to 4:00/5:00 a.m.which required prisoners, most of whom work, to choose between sleep and medical attention.
In the segregation units of both prisons, the absence of SCR boxes meant prisoners had to convey SCRs through security, possibly impeding "timely access to medical care by allowing [guards] to serve as gatekeepers for medical services."
Investigators also found that prisoners with serious medical conditions were often "not referred to a doctor or a hospital in a timely manner," despite a CMS policy requiring prisoners to be seen by a doctor if they reported the same complaint twice. Moreover, no mechanism existed at either prison to ensure prisoners were referred to specialists when necessary. Medical staff could not even track many recommendations because they had not been recorded.
According to the report, one HIV positive prisoner with chest pains and shortness of breath waited two days to see a nurse, only to be sent back to her dorm. She was hospitalized 12 hours later and found to have a potentially fatal HIV-related infection.
Prisoners at both units were denied basic dental services by CMS, which performed "as a matter of practice," only extractions.
The above noted deficiencies in medical care were exacerbated by inadequate staffing, said the report. For instance, CMS employed only one doctor to treat the two units' 1,300 prisoners. This practice of short-staffing is used by CMS nationwide to increase profits.
Mental Health Care
The investigation revealed inadequate mental health care at both prisons. Problems were pervasive at McPherson where investigators "uncovered constitutional violations throughout the mental health care delivery system...."
Investigators found that McPherson prisoners were generally not seen for 2-4 weeks after requesting mental health services, creating a risk that undiagnosed and untreated mentally ill prisoners could harm themselves or others. The mental health staff also failed to schedule regular appointments for prisoners even when clinically indicated, or to properly monitor prisoners taking psychotropic medication.
Mental health care was especially deficient in McPherson's 11-bed Special Programs Unit (SPU), which houses prisoners with severe mental illness. Prisoners in SPU received little meaningful treatment, generally 1 hour of group therapy every 1-2 weeks.
According to investigators, one mentally ill woman at McPherson was "placed.in a restraint chair for more than 45 hours without proper justification." Although she was allowed to walk every two hours, the manufacturer's instructions warned against using the chair for more than 8-10 hours and advised direct medical supervision for longer use. "This did not occur."
In the segregation unit at Grimes, psychiatric evaluations were performed in front of the prisoners' cells, where noise and a lack of privacy could hinder responses and possibly result in "incomplete or inadequate mental health assessments," the report noted.
Investigators deemed the suicide cells at both prisons unfit for suicidal prisoners. Bunks were not bolted down, panic buttons didn't work, there were no intercoms or surveillance cameras, and the small windows mounted in the solid cell doors prevented adequate supervision.
Psychiatric staffs at both units were unqualified to provide proper care. For instance, McPherson's SPU was managed by a single bachelor's-level social worker who was unqualified and incapable of providing "all of the necessary mental health services."
Security, Protection, and Sanitation
Contraband was a problem at both prisons. At Grimes, for instance, guards confiscated 14 shanks, one ice pick, and a box cutter in June 2002. This failure to control contraband and a lack of oversight by guards allowed a prisoner to be stabbed in one of the barracks on April 4, 2002. No guards were present during the attack. Certainly more security problems existed at the prisons, but the report released to the public was heavily censored in this section.
Prisoners were not adequately protected at either prison, where lapses in supervision, privacy violations, and substandard investigations "create an atmosphere conducive to misconduct and abuse." Thirteen incidents of sexual misconduct or abuse were reported between July 2001 and August 2002, according to the report, which noted several specific instances.
On June 13, 2002, a McPherson prisoner was sexually assaulted by a nursing assistant. The assault, perpetrated in an unmonitored examination room, lasted 5 or 6 minutes. The nursing assistant confessed and was fired. Several days later, a guard and a prisoner were discovered in a broom closet about to have sex. An investigation revealed the two had been sexually active for more than a month. The guard was fired.
At Grimes, a female sergeant was fired in the Spring of 2002 for calling a former prisoner. Supervisors said the two were involved in a sexual relationship while the man was at Grimes. On May 8, 2002, another female guard was fired after she was caught in a "compromising position" with a prisoner.
Unsanitary and unsafe conditions existed in the food service programs of both prisons, but appeared to be worse at McPherson. At McPherson, investigators found that dishes, food trays, pots, and pans were not properly cleaned or sanitized. Moreover, inadequate hand washing facilities and a dearth of trash cans rendered guards and prisoners subject to disease. The walk-in coolers were dirty, one containing pools of blood from thawed meat. The walk-in freezer was also dirty.
The report recommended a number of remedial measures to bring the prisons up to constitutional standards. For medical care these measures included increasing on-site physician coverage; providing sufficient staffing; implementing a quality improvement program; implementing programs to ensure that existing chronic care protocols are followed and that asthmatics receive inhalers and are allowed access to the infirmary; implementing policies and procedures for hepatitis C treatment; ensuring special needs prisoners are scheduled for and transported to outside consults and that the consultants' recommendations are followed; and enforcing "existing dental care policy to provide [a] full array of dental services...."
Mental health care recommendations included ensuring that mental health staff make regular rounds in segregation and "provide accurate diagnoses and timely implement treatment plans"; ensuring that mental health requests are responded to in a timely manner and providing a confidential environment for testing and counseling where appropriate; ensuring adequate on-site psychiatrist supervision; improving monitoring and treatment of seriously mentally ill prisoners; providing appropriate housing for suicidal prisoners; implementing a quality improvement system; and ensuring the restraint chair is used appropriately.
Security and protection recommendations included providing adequate security staffing; installing security cameras; revising investigative procedures; "[regularly reviewing] grievances for allegations of sexual misconduct or harassment, and [conducting] full-scale investigations where appropriate"; and restricting unsupervised prisoner movement.
Sanitation recommendations included training kitchen workers in safety and food handling procedures and ensuring proper cleaning and sanitization of "dishes and utensils, food preparation and storage areas, and vehicles and containers used to transport food."
Source: DOJ report
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