Healthcare

4 Comments Posted on All Posts, Inmate Healthcare

Excited Delirium, the Use of Force and the Death of Natasha McKenna

Update: Taser’s role in the rise of excited delirium diagnoses is an important part of this story. H/T to @SusieMadrak

Last week, police in Fairfax County, Virginia, said a medical examiner determined that a 37 year old mentally ill black woman named Natasha McKenna died of ‘excited delirium’ in February after being tased and restrained by six armored sheriff’s deputies.

I had never heard of excited delirium before, so I dug into it a little bit. The American Psychiatric Association (APA) maintains a resource known as the Diagnostic and Statistical Manual of Mental Disorders, or the DSM. The DSM contains a diagnostic classification list that details all the diagnoses recognized by the APA. It’s a pretty big book that details many, many mental disorders and diagnoses. Delirium is a classified diagnosis, but excited delirium is not.

That’s because there is significant and decades-old debate in the medical and civil liberties communities over whether excited delirium is real or if it’s a scapegoat for police brutality. Back in 2003, the Los Angeles Times reported that in-custody deaths involving excited delirium diagnoses were thought to be on the rise:

Although no one tracks the number of suspected cases — nor are there any public records on the number of people who die in police custody — researchers suspect that the condition accounts for a half-dozen deaths in most major cities each year. By some estimates, excited delirium is now being ruled as the reason behind the majority off all in-custody deaths.

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According to neurologists and medical examiners who have researched the issue, excited delirium is an often-fatal condition that can occur in a small subset of people who use drugs, mostly stimulants like cocaine or methamphetamines, over a long period of time. Typically, as users continue to take the drugs, the number of drug receptors in the brain rises, which helps pump dopamine and other excess hormones out of the brain.

But in people at risk of excited delirium, there is a genetic fault that impairs the brain’s ability to increase those receptors, they say. After drug use, that can lead to a dangerously high level of hormones in a part of the brain known as the amygdala, which later can bring on delirium, paranoia and aggression. More often than not, that attracts the police.

In such instances, even a minimal struggle can lead to too much pressure on the heart or lungs and the person can die. Another problem: Long-term stimulant use can enlarge and weaken the heart, which can be overtaxed during a big adrenaline rush. “It’s a very dangerous toxic mix of events,” says Karch.

The excited delirium diagnosis originated in the early years of the War on Drugs in cases involving cocaine. It therefor comes directly to us from a law enforcement and forensic psychiatry setting. The diagnosis is not recognized by many mainstream associations like the APA. Most cases involve people in distress who are often suffering from mental illness or, as the LA Times noted, substance abuse and addiction — and the use of force against them by law enforcement, many times involving tasers or restraints.

Amanda Truscott, writing in the Canadian Medical Association Journal in 2008, explored the dynamic between excited delirium cases and the use of force. She defined it as “being characterized by agitation, incoherence, bizarre behaviour, high temperature, superhuman strength, a high tolerance for pain — and sometimes, the compulsion to break or bang on glass.”

She tells the story of Robert Dziekanski, who died in-custody after a confrontation with police at the Vancouver International Airport:

Dziekanski touched down in Vancouver on Oct. 14, 2007, following a 13-hour flight from Poland and for 8 hours roamed the immigration lounge, steadfastly insisting that his mother would soon meet him. She, meanwhile, awaited his arrival in the baggage claims area, while airport officials did nothing to ensure the pair could connect. Lost, confused and unable to speak English, Dziekanski used office chairs to build a makeshift barricade between a pair of glass doors as if to ensure that no one could remove him from his meeting place with his mother. Obviously frustrated, he began to throw computer equipment onto the floor and against a glass wall. The police were summoned and in stunning sequence of events captured on video by an eyewitness’s cell phone, Dziekanski was pinned the floor, shot by a taser and eventually died.

The police said medical examiners determined that Dziekanski died of excited delirium.

In cases where an ‘excited’ person is restrained, tased and pinned to the floor and later dies, the excited delirium diagnosis introduces a level of ambiguity that absolves officers of responsibility for that person’s death. While most rational people would read these stories and conclude that, justified or not, it was the struggle and use of force that killed these individuals, excited delirium diagnoses shift the blame to the victim.

After all, isn’t this the primary tactic in law enforcement and criminal justice that got us to this very point of mass incarceration and extreme racism and brutality on behalf of cops and corrections officers? I do not believe the excited delirium diagnosis is all that different from the “super predator” myth of the 1990’s that helped fill American prisons by dehumanizing young black men as animalistic and aggressive. Instead of being treated as patients or just people in need of a crisis intervention, those who are said to have died of excited delirium are similarly labeled as dangerous monsters that needed to be put down.

In light of all of this, it’s fair to say Natasha McKenna’s purported cause of death could probably use an outside 2nd opinion.

h/t my old friend Kirk Murphy for bringing this to my attention

1 Comment Posted on Rikers Island

Against Reform: Beyond Rikers Island

There are a couple of things I want to say about the 10 reform bills proposed in the NYC Council this week targeting the Department of Corrections.

First, as I mentioned in my rundown, even if these bills pass, they will be meaningless without rigorous enforcement and oversight by the council. Much of the problem here is not that the city lacks regulations over its jails — it’s that the Department of Corrections seems to follow its own rules and break theirs with impunity. For evidence of this, read pretty much any post I’ve written about Rikers Island.

My next point is more of a confession and a question than anything else. I understand why the council is leading its charge with bills aimed at transparency and reporting. They need this data in order to make well-informed decisions about how to change laws governing incarceration in New York City.

But in the end, I can’t help but think back to the final chapter of Nell Bernstein’s incredible book on ending juvenile incarceration, Burning Down The House.

In the chapter titled, “Against Reform: Beyond the Juvenile Prison,” Bernstein writes:

A great strength of our democracy, our reformist nature is also a critical weakness, blinding us to those occasions when a long-standing institution has a fundamental, conceptual flaw– the kind that demands not a wrench but a wrecking ball. If a reform proves inadequate, we simply try again. Another task force is assembled to supplant a now-defunct commission; new committees are assigned to exhume the wreckage of the old. Sometimes, these efforts pay off, and progress — our national religion — is attained. But there are also occasions when our reformist zeal leaves us patching the roof of a building that lacks a foundation.

Are the Mayor and the City Council approaching their criminal justice crisis with the “wrecking ball” it deserves, or the “wrench?” By maintaining juvenile incarceration, establishing the ESHU and keeping Corizon (among other things), is New York “patching the roof of a building that lacks a foundation?”

14 Comments Posted on Inmate Healthcare

Medical Examiner Says Mentally Ill Inmate Natasha McKenna Died of Excited Delirium

UPDATE: More on ‘excited delirium’ and its diagnosis in in-custody deaths involving the use of force.

According to the Fairfax County Police, a medical examiner has ruled that 37-year old inmate Natasha McKenna died of ‘excited delirium’ while in custody last February.

Natasha suffered from schizophrenia and bi-polar disorder, and was arrested on January 26th after she called 911 to report she had been assaulted. After taking her to the hospital, police realized they had a warrant for her arrest stemming from an alleged assault on a police officer a few weeks earlier.

After a few days behind bars, Natasha’s condition deteriorated rapidly to the point that jail officials felt it necessary to remove the distressed 5’3″, 130 pound woman from her cell using six armor-clad sheriff’s deputies, a spit hood, restraints and tasers.

It’s unclear whether Natasha was receiving any kind of mental health treatment prior to her detention, and there hasn’t been any indication yet of the quality of care she received behind bars.

If the Fairfax County Police were negligent in providing adequate mental healthcare to Natasha, and thereafter chose to use brute force, weapons and restraints to confront her, it’s not hard to see how she might die from a state of excited delirium.

6 Comments Posted on All Posts, Inmate Healthcare, Privatization, Rikers Island

Corizon Health Staff on Rikers Island File Federal Labor Complaint Over Dangerous Work Environment

According to the NY Daily News, a group of medical staffers from New York City jail medical contractor Corizon Health Services filed a federal labor complaint with the Occupational Safety and Health Administration (OSHA) on April 11th for Corizon’s failure to protect them from inmate assaults.

From the Daily News:

The staffers charge that the nation’s largest jail health care provider repeatedly failed to protect them from dangerous inmates who were never properly restrained or labeled as serious threats, given their prior case histories.

The OSHA complaint cited an assault on a petite nurse who was brutally punched in the head by a 6-foot-tall, 160-pound inmate during a mental health assessment in a prison clinic on April 6.

“He hit me several times on the side of my head, arms and shoulder,” said the unidentified nurse, who suffered multiple bruises on her arm and shoulder.

In September of last year, Corizon was fined $71,000 by OSHA for failing to protect employees from violence, including “one willful violation for failing to develop and implement an effective workplace violence prevention program for its employees.”

Since then, city officials have scrambled to reform practices and policies concerning the conduct of medical staff and correction officers. But the changes appear to be slow-going: a recent report on the new Enhanced Supervision Housing Unit found that many medical staff were sometimes too afraid to work with inmates when they were locked out of their cells. They also encountered difficulty finding appropriate space in the ESHU to conduct their sessions. Along with chronic understaffing, poor recruitment and limited training, factors like these can quickly conspire to obstruct the delivery of medical attention and care to inmates.

It is in this setting that the city asks medical staff to make critical and often life-or-death determinations, such as those pertaining to the placement of inmates in solitary confinement — despite the fact that such demands are, as one recent report found, in fundamental opposition to medical ethics.

The city is said to be considering ending its contract with Corizon, which wouldn’t fix everything but would be a great place to start making some real changes. I’m still wondering: How many more of these incidents will the NYCDOC tolerate before they cancel this contract?

6 Comments Posted on All Posts, Inmate Healthcare, Rikers Island

Report: Rikers Island Health Staff Shouldn’t Participate in Solitary Confinement Placement Process

The Associated Press got a sneak preview of a new study that found the medical ethics of healthcare workers on Rikers Island are seriously compromised — especially when they are involved in placing inmates in solitary confinement:

The two-year study at New York’s sprawling Rikers Island jail complex concluded with a bold recommendation to remove health workers entirely from the most contentious issue they face — whether to put an inmate in solitary. That’s because many doctors believe the confinement, which involves 23-hour stretches of isolation, could harm inmates.

Additionally, over 90% of health workers reported they treated an inmate for what was filed as a fight with another inmate, when in fact the inmate claimed to have been assaulted by guards. 16% had “heard of or seen” guards beating inmates at the health clinic. Many acknowledged concern over retaliation if they reported guard-on-inmate violence.

Unfortunately, the report’s central recommendation to remove healthcare workers from the placement process for solitary confinement directly contradicts the new rules adopted by the Board of Correction this past January. Continue reading →

“[D]uring this [time], no mother will work in the detention center, nor will we send our children to school, not will we use any services here, until we are heard and approved: we want our FREEDOM.” Originally published at Colorlines.com.
Posted on All Posts, Immigrant Detention, Privatization

Undocumented mothers put in solitary after 78 launch hunger strike at private prison

Last week, seventy-eight incarcerated mothers at GEO Group’s Karnes County Detention Center in Texas signed a letter announcing a hunger and work strike and to demand their immediate release. Now Roque Planas at the Huffington Post is reporting that some of those mothers were put in solitary confinement with their children in response to the protest.

Aura Bogado obtained the prisoners’ letter for Colorlines.com, and writes that “most have brought their children from Guatemala and El Salvador—countries with some of the highest femicide rates on the planet.” She continues:

The mothers who’ve signed the letter have all been interviewed by immigration officials and have established a credible fear of persecution or torture if they were to be deported. But they either haven’t been given an opportunity to post bond for release, or the bond amount has been set too high. Their letter, in part, reads:

“[D]uring this [time], no mother will work in the detention center, nor will we send our children to school, not will we use any services here, until we are heard and approved: we want our FREEDOM.”

The strike began Monday with some 40 women and it has no definite end date. At a facility like Karnes, where detainees run a lot of the essential services, a strike can also impact people who aren’t participating.

An immigration officer I spoke with at Karnes who repeatedly declined to give her name laughed when I called on Tuesday. I asked why she was laughing and she answered, “These attorneys convinced them all to do stuff,” and shortly thereafter they hung up on me. Phone calls to GEO Group staff at Karnes have not been returned.

At so-called “family residential detention centers” like Karnes, mothers and children captured crossing the US-Mexico border are incarcerated together. The women are paid $3 per day to help run the facility. Because Karnes County is also home to massive fracking operations and water contamination, many have to drink bottled water — which happens to cost $3.

This demonstration is the latest in what appears to be a growing protest movement by immigrant detainees at private prisons across the country. Last year, hundreds of immigrant detainees staged a 14 hour protest against their mistreatment and conditions at the CCA-operated Northeast Ohio Correctional Center in Youngstown. The Bureau of Prisons decided not to renew that contract. Those inmates were sent to federal prisons elsewhere in the country.

In February of this year, immigrant prisoners at the MTC-operated “gladiator school” tent city in Raymondville, Texas, began a demonstration in which several of the Kevlar-domed housing units were damaged by fire. That prison has been closed and the inmates have been moved to other federal prisons as well.

In both cases, the communities that hosted these private prison companies suffered greatly. Youngstown, which like many towns throughout America is still recovering from the recession and the offshoring of industry, lost 185 jobs at once. It is expected to lose millions in tax revenues — money meant for education and other essential public works. Over 360 people lost jobs in Raymondville after the protest at Willacy. S&P recently downgraded the Willacy County’s bonds to junk, and taxpayers in both communities will be left to fill the budget gaps. These are some of the very real consequences of prison privatization that people rarely talk about: what happens to the community when things get so bad they suddenly lose their contract?

And as for the prisoners: the response to their demonstrations seem to be a double-edged sword. Will the action at Karnes escalate to the point of Youngstown and Willacy, forcing the government to act and even cancel the contract? More importantly, if that happens, will the prisoners’ demands be met or will they be ‘disappeared’ throughout the country like the others?

4 Comments Posted on All Posts, Inmate Healthcare, Privatization

Lawsuits highlight multiple inmate deaths under private contractor in Pennsylvania

On March 27th, a jury in Lehigh County, Pennsylvania, found that private jail medical contractor PrimeCare Medical Inc. was negligent, but ultimately not responsible for the death of 27-year-old inmate Travis Magditch.

The Magditch family sued PrimeCare and Lehigh County in 2012 after Travis was arrested for allegedly possessing drug paraphernalia and died of an asthma attack at the jail one day later.

The family’s attorney, David Inscho, told jurors this was Travis’ first time behind bars. He stated that he had “called his parents when he got there, begging to be bailed out.” The local police offered to release Travis into his father’s custody, but having seen his son struggle with heroin addiction for two years, he decided against it. Mr. Magditch believed this decision would force Travis to “get help for his drug addiction” and enter rehabilitation.

Travis had a history of suffering from severe shortness of breath due to asthma. The complaint states that he was assessed to have “severely low” lung function when he first entered the jail. Documents show medical staff noted his past with asthma and heroin addiction, including his prescriptions and use of an inhaler. They noted who his doctor was and how to contact the pharmacy to order his medications. But according to the lawsuit, medical staff only placed orders for some of his medications. Most notably, the inhaler was not included.

The morning after his arrest, the lawsuit claims that Travis was seen for sick-call and was assessed to be at level 1 – the highest priority level for medical care. Again, medical staff noted his history with asthma. Nonetheless, he was returned to his cell without a rescue inhaler. Continue reading →