Lockdown on Rikers (22 page)

28

Thankfully, the two weeks without George passed by uneventfully. Although he returned as scheduled, his interest in work was halfhearted, and for an upcoming unit chiefs meeting, he asked me to go in his place. Every other week, the jail's unit chiefs met with St. Barnabas senior staff at “Central Office,” their administrative base at the river's edge. I was a little excited to be tapped for this, recalling the years at GMDC when Pat had attended these meetings with the Montefiore brass and returned with news and directives for us.

I decided the occasion called for a suit, and it was with excitement that I drove over to Central Office. In the conference room, I grabbed a seat next to the unit chief of the Tombs, the Manhattan borough jail. Across the room, Charley waved to me. While we waited, everyone was whispering about the usual topic—who was quitting and who was trying to ride it out.

Shortly, the Central Office team made their way in, led by Dr. Alan Campbell, the new director of Mental Health, trailed by Hugh Kemper, a clinical psychologist, and Frank Nelson, a hospital administrator. Bringing up the rear was Suzanne Harris, the deputy director, wearing, of all things, a Yankees baseball uniform! In her pin-striped get-up, busting at the seams, the number-two person in charge of mental health services for the entire New York City jail system trotted to the center of the room, gesturing for all of us to get up and clap. I looked down at my patent leather
shoes and glanced over at a shrugging Charley. Harris pumped her fists in the air: “Go Yankees! Go Yankees! Go Yankees! Come on, everybody—up!” Dutifully, we all rose and cheered the hometown heroes.

When the impromptu pep rally concluded, we cautiously sat back down. Time for business. (We hoped.) The first item on the agenda was departing personnel and the negative press that had dogged St. Barnabas since they'd arrived. Already they were making critical mistakes, mostly delays in sending sick and injured inmates to the hospital. Under ordinary circumstances this would have gone unnoticed, but because of the controversy surrounding the contract, their every move was being scrutinized; at every turn the media were swirling. A barrage of newspaper articles highlighted instances of poor patient treatment and questioned the quality of inmate health care provided by an inexperienced vendor motivated by profit.

All eyes were on Dr. Campbell, a big man with salt-and-pepper hair. “Look, folks,” he started. “Any time there's a changeover, there's bound to be upheaval and resignations as new changes are implemented. It's to be expected. We're working toward a more streamlined, efficient operation. That's what we're known for. In the meantime, we just have to be patient and work a little harder. Don't worry, by the time we're through, things will settle down, the newspapers will go away, and you'll all have enough staff.”

A few doubtful glances were exchanged, but nothing further was said.

He then switched to patient charts, impressing on us the importance of keeping chart entries up to date, neat, and legible. “Everything we're doing is being closely monitored, and it's being done through chart audits. It's critical that we do well on these audits.”

With this news, I had no doubt everyone was silently groaning. In the past, audits were an annual event conducted by the State Department of Mental Health. But now, the city was performing its own audits as a way of keeping tabs on its new vendor. The
frequency of these reviews threw us into a perpetual state of paperwork overdrive, which also had the unfortunate effect of changing the role of the clinical supervisor. Whereas supervisory sessions had historically been rich in education and a clinical review of cases, this precious weekly hour was now devoured by chart inspections. The paperwork demands had become so weighty that the clinical supervisors, many of them psychologists, were dubbed “chart jockeys,” and we often lamented that the patients were becoming a mere footnote to the almighty chart.

Sensing the displeasure in the room, Hugh Kemper reminded us of St. Barnabas's plan to computerize the charts, which would make our paperwork lives that much easier. We nodded politely. Although it sounded promising, it was years in the offing.

After a few more routine matters were addressed, the meeting ended with a hearty, “Hang in there and keep up the good work. Everything's going great!”

Although that's what we all wanted to believe, I don't think anyone really did, and it was a depressing drive back to AMKC. Inside the jail, I walked into a pileup of civilians being held at the entryway gate while an alarm was in progress. In the main control booth, a soundless red “siren” was whirling around, its long red rays careening off the walls of the central corridor. Through the bars, a swarm of COs in helmets and carrying nightsticks silently marched three inmates to the receiving room. Two of the inmates walked with their arms behind their backs, wrists bound by white plastic handcuffs; the third inmate's hands were atop his head, fingers interlaced. I wondered what awaited them in the receiving room. Another depressing thought.

When I reached our wing, the usual line was backed up outside Hart's Island, and I nodded to the patients as I passed by. It felt strange that I didn't know any of them personally anymore. And to them, I was just the lady with the clipboard. Even though I'd only been an administrator for a matter of weeks, my close connection with the inmates was fading away. To try to stay connected, I decided to pop in on one of the houses before starting my day.

I stepped into a group session under way in the dayroom. About eight men were seated in a circle engaged in the usual topic, drug addiction. (My colleagues and I sometimes kidded that if drugs were ever legalized, there would be about ten inmates left on Rikers Island.) I stood back in the doorway and listened to the conversation. A middle-aged man had the floor and said, “It's okay while I'm in here. I feel good, I take my meds, but when I get out and go back home, there's drugs all around me. You start picking up, and you just forget all about the meds.” The others nodded.

I tiptoed out so as not to disturb the process. These men were doing so much better than when they'd arrived. They'd be returning to their referring jails soon. It was a good feeling to see how far they had come. But I couldn't help but wonder what would happen when they left Rikers Island. This was a constant worry for them and for their families. There was a flip side to my conversations with Helen Tucker, whose son Michael I'd worked with at GMDC. As thrilled as she was by Michael's improvement, many of our talks had wound up with her in tears when she contemplated what was next. “What will happen to him when he leaves Rikers? There's no day program for him, no place to go. He'll be right back on the streets. Oh, dear God, what will happen? What will become of my son?” There was little I could say to comfort her. Upon release from Rikers, the inmates, mentally ill included, are simply dropped off at a bus depot in Queens. When I first arrived at Rikers, I was shocked to discover that there was no discharge planning for the mentally ill, that they were normalized on our Mental Observation Units and it all ended there.

But during my tenure at GMDC, a potential solution to this gap in care emerged. In the mid-1990s, a spate of crimes committed by the mentally ill drew media attention to the callous and potentially dangerous practice of dumping released mentally ill inmates onto the streets. Under public pressure, the city instituted the Link Program, a plan designed to “link” the mentally ill to outside programs prior to release. Enthusiastic Link counselors sat in at our staff meetings and explained the basics. Our job would
be to identify the sickest patients—the SPIMIs—and refer them to the Link counselors, who would assess their appropriateness for a program. Since many of our patients fit the “severe and persistent mentally ill” category, the Link counselors were quickly inundated with referrals.

However, there were several catches, the first being that the legal charge had to be for a nonviolent, low-level crime. Unfortunately, many arrived facing serious charges, since it was common for initial charges to be inflated. In most cases, these charges were ultimately reduced, but the Link criteria were inflexible: the
initial charge
was what counted. This alone immediately eliminated most of our patients from consideration. The next problem was even thornier: the interpretation of “nonviolent, low-level.” In one case, I filled out a Link referral for a paranoid schizophrenic charged with burglary, the particulars of the crime being that he'd swiped a broom from in front of an apartment building. Although interviewed by Link, he was ultimately rejected because of the “violent nature” of his charge. When I protested that burglary—by definition—is nonviolent, I was told that since there had been the
potential
for violence, he was disqualified. After numerous such rejections, I lost enthusiasm. The counselors themselves had grown discouraged, too, as the narrow acceptance criteria were not the designs of Link but of outside programs. The scarcity of outside resources meant that these programs could be picky and were skittish about admitting released inmates. I submitted dozens of referrals, and although doing so built up the patients' hopes that they were going to a program, it rarely happened. Of course, the irony is that if the patient who'd swiped the broom had been in supervised community treatment, it's unlikely he'd have been arrested in the first place.

The Link program had the right idea, but the complexity of providing psychiatric support for released inmates was simply beyond its scope. I thought it a tragedy that our patients were missing out on this, especially since most weren't dangerous and were charged with minor offenses.

Not everyone, however, fit the minor offense category. The ultimate tragic consequence for failure to care for the mentally ill occurred in January 1999, when Andrew Goldstein, a schizophrenic, shoved a woman named Kendra Webdale off a subway platform into the path of an oncoming train. Her death rocked the city, spotlighting the problem of the mentally ill roaming the streets.

To compound the tragedy, Andrew Goldstein knew he was ill and for years had sought help in coping with the taunting voices that flooded his every waking moment. Hospital records verified that Goldstein had repeatedly shown up at their doors, begging for help. The standard care he received was a prescription. Absent the necessary support and supervision, he was alone in the world and, in a severely compromised state, fended for himself as best he could. At his trial, the defense carped on this, laying partial blame for Webdale's death on the State of New York. Meanwhile, newspaper headlines portrayed him as a demon.

After his arrest, he wound up briefly at the Mental Health Center. But as he sat in our on-call room, there was nothing demonic about him. He was simply a tormented human being. But by the time Goldstein reached us, the whys and wherefores of his crime no longer mattered. Our sole objective was to get him out, and get him out fast. Since the Kendra Webdale story was front-page news, Andrew Goldstein was a “celebrity inmate.” When headlines trumpeted particularly heinous crimes, the inmates, many guilty of serious crimes themselves, become righteous and indignant. This created a crisis, since neither we nor DOC wanted anything to befall a highly publicized inmate on our watch. Goldstein never made it past the on-call room; we hastily transferred him to a smaller, more secure unit in a city hospital prison ward.

After he was gone, we followed his case in the press. Ultimately, he was found guilty of murder and sentenced to twenty-five-to-life. Several years later, the conviction would be overturned on appeal, and in 2006 Goldstein pleaded guilty to manslaughter and was sentenced to twenty-three years. Kendra Webdale's death was all the more horrendous, and Andrew Goldstein's life all the
more tragic, because Goldstein had tried to get help—help that does not exist.

But if any good could have come from this, it was Kendra's Law. Enacted in 1999, this law enables families and others to obtain court-ordered treatment for mentally ill people deemed at high risk for violence as a means of preventing future tragedies.

29

Despite Central Office's insistences to the con
trary, health-care services on Rikers Island were deteriorating, and nowhere faster than at the Mental Health Center. My initial hopes of supporting the staff in a meaningful way fell by the wayside as my job was reduced to a scramble to plug empty shifts. My interaction with the overworked staff amounted to settling squabbles and serving as a sounding board for tearful outbursts. Most were already doing double shifts, yet we were forced to borrow staff from other jails. But our biggest problem was a shrinking psychiatrist pool. As doctors resigned through normal attrition, there was a long lag in replacing them. St. Barnabas was trying to replace these physicians—most of whom had limited licenses—with fully licensed doctors. The limited license doctors, the medical backbone of Rikers Island, were mostly foreigners. Like Alex, my former beau, they needed to pass stringent exams to become fully credentialed here. While they studied, they practiced medicine under provisional state licenses. This arrangement had worked well for years, providing the jails with a steady stream of physicians. But in their zeal to snare the contract, St. Barnabas had naively agreed to utilize only fully licensed doctors. For fully licensed doctors, with a wide array of employment options, jail is simply not an appealing workplace.

Undaunted, Central Office was having some recruiting success with moonlighters, fully credentialed psychiatrists looking to
make extra money working overnight shifts. While their presence provided badly needed coverage, the presence of these anonymous late-night doctors only added to an overall sense of fragmentation. But worse, their arrival had unexpectedly dangerous consequences.

One morning, I got a call from a housing officer, reporting that a schizophrenic named Josiah Parker wasn't bathing and was behaving erratically. “I'm afraid he's going to get jumped,” the officer warned.

When I arrived at the dorm to investigate, the patients were up and about, having just finished lunch. The remains of the meal still lay on the plastic trays. Somehow, the food never managed to resemble the mouth-watering fare depicted on the menu taped to the bubble window. Although standard and kosher meals are offered, both managed to look exactly the same: brownish glop, seasoned with packets of ketchup, washed down with the standard jailhouse beverage—Kool-Aid.

Wearing an array of hats, caps, and do-rags, the patients were returning trays to the food wagon, lighting up cigarettes, and milling around. A few talked on the phones, others waited their turn. In the dayroom the TV was blaring, and wet clothes were spread out on plastic chairs to dry (clothes were washed in buckets of water). A few of the more health conscious were doing push-ups. Contrary to popular jail folklore, I never saw a weight room or extravagant recreational facility at Rikers. In terms of outdoor recreation, some of the newer jails maintained spacious, evenly cemented yards with basketball hoops, but the older jails offered nothing more than small patches of grass and broken cement set aside for “recreating.” Although entitled to one hour of outside “rec,” not every house goes out at an optimal time of day. The rec time slot for this dorm was 7 a.m. Due to the early hour, most never made it outside at all, especially during the winter.

With lunch just finished, one of the highlights of the day was over and the patients were already curling back up in their cots. A common strategy for surviving jail was to try to sleep away the months between court appearances.

I was disheartened to see that nothing therapeutic was going on. The interview rooms were empty, and the scene throughout the day would differ little from this. Ordinarily, each patient would have had two mental health sessions a week, one with a clinician and the other with a psychiatrist, buttressed by daily group therapy. But now, all group therapy had ceased, and instead of being seen by both a psychiatrist and clinician, each patient was being seen just once a week—either by a clinician or by a psychiatrist, and the contacts were brief. The therapist had little time for more than a quick superficial dialogue, and the psychiatrist an even quicker medication renewal. Even worse, because we were borrowing staff from other jails, the patients rarely met with the same person. Although these contacts kept the treatment in compliance from an auditing perspective, quick encounters with different faces could hardly be called therapy. Far from a higher level of care, the Mental Health Center now provided the skimpiest care possible.

Since our staff presence in the houses was scarce, as soon as I arrived, I was surrounded by a sea of anxious faces with complaints ranging from medication side effects to requests for a return to GP. I jotted down names and issues.

At the head of the dorm, just outside the bubble, three cots were outlined by red tape on the floor. These were “enhanced suicide observation” cots, designated for those at high risk for suicide. Seated on the edge of a cot, a youth quietly wept, a thick pinkish scar circling his neck, indicating a previous hanging attempt.

I walked over to him. “What's wrong?” I asked.

He looked up at me sadly. “My mom's in the hospital and she's doing bad. She got sugar.”

“Sugar” meant diabetes, which was rampant among the inmates and their poverty-stricken families.

“I need to make a long-distance call to talk to her. She's in a hospital in Jersey. I need to talk to her—she could die. How can I get to Social Services?”

Another anguishing situation. I had to tell him that Social Services was virtually nonexistent. Although we'd been able to arrange
long-distance phone calls at GMDC, here we didn't have the same phone setup, so I was unable to help him with this. But I did tell him I'd pass his name on to the “Social Services Department” just in case something could be done. I also made a note to have his clinician and doctor check on him.

He wiped away the tears and thanked me.

Stepping away, I practically bumped into two young Latinos who'd patiently waited their turn. “Miss, look!” said the older, shorter one, pointing to his skinny sidekick. This was a translator situation, another common scenario. He chattered a quick command in Spanish, and his pal whipped up his T-shirt to display a gaunt rib cage, complete with a gunshot scar. “You see that?” said the shorter one. “He's losing too much weight! He needs to see the dietician so he can get double portions of food.”

The dietician was just as overworked as the Social Services worker, but, regardless, I informed the inmate of the procedure. “Tell your friend to go to the clinic, and if a nurse or doctor says there's a problem, then they'll refer him to the dietician. They're the only ones who can make the referral.”

“Oh, okay, miss, thank you.” He translated the information back to his friend. The younger patient, who couldn't have been more than nineteen, backed away, bowing and muttering,
“Gracias, gracias.”

At the rear of the dorm, a foul smell was growing stronger, and I traced it to a rumpled-up patient who had to be Josiah Parker.

“He stinks,” shouted one of his neighbors, who was holding his nose. “It's horrible to have to sleep next to him. He's up all night looking around the floor for cigarette butts.”

“We take our meds, but he doesn't. Can't you get him out of here?” said another.

Parker, completely oblivious, continued his dialogue with no one.

“I'll take care of it,” I said, pulling out a transfer form. He would probably wind up on the miserable Lower 1 and 3, since that's where we always seemed to have spare beds.

I was just finishing up the form when I noticed an older man who'd stood back, waiting to speak with me alone. With a cautious expression, he drew me away from the cots. Satisfied we were out of earshot, he whispered, “There's a gang in here and they're terrorizing everyone. They're taking commissary money, threatening to beat up anybody who doesn't do what they say, and they're running around at night torturing the really sick guys. You see that guy, Parker?”

“Yes,” I nodded. “He's going to be moved out of here.”

“Good, 'cause last night while he was sleeping and his feet were dangling off the bed, they were lighting matches and burning his toes. Everybody's afraid to go to sleep, that they're gonna get set on fire. It's really scary in here, especially at night.”

“What's the CO doing while all this is going on?” I asked, already knowing the answer.

“Are you kidding? He isn't even on the floor. He's in the bubble sleeping and nobody better wake him! Even if you wanted to, nobody wants to be a snitch.”

“Snitch” is the lowest form of jail life. “Snitches get stitches” is the oft-quoted, self-explanatory jailhouse mantra, and I knew this man was taking a big chance just talking to me about this. When I asked him to name the culprits, he didn't hesitate, nor was I surprised, as their names were always popping up as problems at our clinical meetings. I thanked him for the information, which gave me new ammunition in our efforts to discharge them.

I left the house with a growing sense of helplessness. There were so many moments when I'd felt frustrated by my inability to do something for those in a horrible predicament, such as the patient who couldn't make a simple call to his gravely ill mother. And then there was the kid who didn't speak English. I was sure he was Dominican; Rikers was full of inmates from the Dominican Republic. Through my sessions with them, they'd described impoverished lives in their native country, of growing up hungry with no medical care, of tapeworms and dilapidated shacks that flooded every time it rained, of no education, no government assistance—just
poverty, sickness, and despair, with zero possibility for anything more. With nothing to lose and high hopes for America's opportunities, young Dominicans flocked to the United States in droves in the early 1990s. With legitimate jobs hard to come by, many resorted to drug trafficking. Despite their plans to make fortunes and return home as heroes, the drug trade usually only led to draconian sentences in US prisons, or a return home in a coffin.

What especially bothered me was that the jails were filled with so many ordinary people who simply had been born into circumstances that most of us couldn't begin to imagine, and they were just trying to survive. I constantly tried to figure out the whys and wherefores of life's gross inequities, but it was futile. But the one bright spot for me was always the valuable human attention we provided through our mental health support. In relating to these people with dignity, care, and respect, we were water on arid soil. But now, with all this cost cutting, even that was being chipped away. Maybe from a bean-counting perspective this fragmented style of care was working out well, but from the standpoint of anything meaningful, I feared that all was being lost.