Lockdown on Rikers

by Ms. Mary E. Buser

  I extended my hand to a squat officer with a whiskered chin. But Putney simply glared at me. “There’s a lot of knuckleheads in here, nothing wrong with ’em!”

  “Oh, come on, Putney,” George chided. “A lot of these guys are very sick, and you know it.”

  “Yeah—and a lot of ’em ain’t.”

  George didn’t have to explain this scenario to me. It was an all-too-familiar example of the tension between the Mental Health staff and the Department of Correction when it came to the mentally ill. For the most part, DOC was of the view that the mentally ill were faking it. They made their own frank assessments, which they were only too happy to share. To us, the mentally ill are patients; to them, they are inmates. To us, they are sick and often misunderstood; to DOC they are manipulators who are always trying to “get over.”

  With a wink from Toussant and a grunt from Putney, George and I departed Hart’s Island. Across the hall was the new admissions dorm, which George explained was a temporary way station for the newly admitted. “Treatment begins here, and we also do a more in-depth evaluation before we move them into one of the other houses.”

  Inside the dorm, most of the patients were still dozing in their cots; others milled around in various states of dress, toothbrushes and soap in hand. A scruffy older man looked around with wide-eyed newness, awakening not just to the day but to lucidity. It was a familiar scene, complete with the morning cigarette haze, not at all unlike the Mental Observation Units at GMDC. In a little while, food wagons would arrive with lunch trays, and nurses would push in pharmacy carts laden with medication. The patients would line up for meals, and line up again for their Dixie cup full of pills. After that, there would be group therapy and maybe a staff-supervised game of bingo.

  Off to the side were two small offices where Mental Health workers were meeting with the earlier arrivals. “We have a clinical meeting at eleven o’clock every morning, and they’ll report on the newcomers,” said George.

  We then checked in on four more houses, which were more of the same—the jail system’s sickest inmates rousing to another day of life and treatment behind bars.

  Our only remaining business was a visit to Lower 1 and 3, the two houses not contained in our wing. “Hope you’re up for a walk!” George said.

  At the end of the wing, an officer unlocked the barred gate that separated our unit from the main jail. We stepped into AMKC’s wide hallways, which were buzzing with morning activity. Navy blue–uniformed COs, two and three abreast, strode confidently down the corridor while a smattering of inmates, passes in hand, hurried along in a more subdued manner. The “beep-beep” of a motorized golf cart alerted us to step aside as an intent-looking CO with two captains aboard maneuvered through pedestrian traffic and zipped down the hall. A parade of linen wagons rumbled by, powered by white-uniformed inmate workers. Another crew swabbed the floors using string mops overly saturated with the jailhouse standard: pine-scented disinfectant.

  We walked through seemingly endless corridors that narrowed down to thin passageways. Over the years, in order to accommodate a growing inmate population, the jails were enlarged using prefabricated extensions that resulted in mazelike structures, and this trip to Lower 1 and 3 revealed this haphazard design. We kept going until we reached a remote section of the jail. Finally, big black lettering spelled out “Lower 1 and 3.” Its old oak doors reminded me of an elementary school classroom, except the panes of glass were cracked or missing altogether. With no electronic buzzers here, George pounded the door and a bored CO meandered over with his big key. When he pulled the door open and we stepped in, I was stunned by the deplorable condition of the house. The damp cinder-block walls were mottled with mildew, and wide swaths of peeling paint hung perilously over our heads. Two dreary dayrooms sat empty.

  Tentatively, I followed George down a dimly lit tier. Upon peering into the cell windows, it was immediately obvious that these patients were much sicker than the men back in the main wing. Some were pacing and muttering; others, clothes in tatters, lay still on their narrow cots. A few yelled out to us, trying to get our attention, but it was hard to discern real concerns from psychotic rants. One man with a matted beard stared straight ahead through the window of his door, chanting, “My wife’s a millionaire, but my hat doesn’t fit!”

  “Shouldn’t they be sent to the hospital?” I asked George.

  George shook his head. “Things are different now. Hospital runs are expensive.”

  “So what do we do? How do we treat them?”

  “We wait. Even without meds, they often cycle in and out of psychosis, and when they straighten out a little, we try to persuade them to take the meds. A lot of times it works.”

  “Seems kind of primitive.”

  George shrugged.

  I felt a terrible sadness for these tormented souls who’ve so long been misunderstood. Centuries ago, their odd behavior was attributed to possession by demons, and the afflicted were treated accordingly. Other horrible myths took hold, such as the belief that the mentally ill are impervious to temperature extremes and therefore were denied heat during the winter and chained to the walls of cold, dark asylums.

  More recently, large state psychiatric hospitals took over the age-old problem of caring for the mentally ill. But over time, even these hospitals deteriorated and needed to be shuttered. With the advancement of powerful antipsychotic medications, the new hope was that mental illness could be managed with medication and supervised community housing. But that second, vital component—the supervised housing that the mentally ill needed and their families yearned for—never materialized, and medication alone often is not enough to support an independent life. Instead, massive numbers of mentally ill remain in a chronic state of psychosis, rendering them unable to attend to the simplest demands of daily living. In the absence of some kind of intermediary supervised care, they live on the streets, shuffle between family members, get into petty mischief, and wind up in jails and prisons, the new caretakers of the mentally ill.

  While we waited for the CO to let us out, I couldn’t help but think that despite all the recent breakthroughs in the treatment of mental illness, this dungeon-like facility of Lower 1 and 3 made it seem like we hadn’t come very far at all.

  27

  Over the next few days, George introduced me to my new administrative responsibilities: maintaining shift coverage, figuring payroll, calculating the daily census, and tracking statistics. I wasn’t crazy about these tasks, but I understood that they came with the territory. More important, George and I were hitting it off nicely. George was another seasoned veteran, and I hoped that with his guidance I would ripen into a competent manager. But it would never be. Less than a week into my new job, George called me into his office and shut the door.

  “I need to let you in on something, Mary,” he said with a sheepish look. “I’m quitting. Yes, I know this is a terrible introduction for you, but I just don’t trust this new outfit. I don’t trust St. Barnabas. They don’t know what the hell they’re doing. I’m here close to fifteen years; I helped to create this Mental Health Center.”

  “But they’re new!” I protested. “Montefiore was here for twenty-five years. You can’t compare the two—St. Barnabas is still learning. Things are going to get better.”

  “No, they’re going to get worse. People are leaving here in droves.”

  I was stunned. In an instant, all the good feelings about my promotion were gone. I knew that hospital staff was leaving, but I’d also assumed the exodus would taper off. My strategy was to duck and dodge the chaos until things settled down. But there was no more ducking and dodging. The reality of the hospital changeover was hitting me in the face. Suddenly, I longed for the pre–St. Barnabas days and the Rikers life I’d known. I was half-tempted to run back across the street—back to GMDC. But there was no turning back. And even if I did, St. Barnabas was maki
ng sweeping changes, changes from which even GMDC would not be immune.

  But George had one more shocker. “I need time to job hunt. As of next Monday, I’ll be going out for a couple of weeks and you’ll be in charge.”

  “But I just got here!”

  “It’ll be okay. You’ll be able to reach me on beeper, and plus Karen will help out. We have a lot of systems in place. The place practically runs itself. It’ll be fine.”

  I didn’t feel like it was going to be fine, but there was nothing I could do. Other than resigning, which I was not ready to do, I had no choice but to ride out the storm. Tough days were ahead. But as I numbly left George’s office, I never could have imagined just how tough they were going to be.

  The following Monday morning arrived more quickly than I would have liked. One of the perks of my promotion was a coveted “Gate One” pass, which allowed me to drive directly to the jail, bypassing the parking fields and route buses. The small pleasure that I felt in passing the buses along the road vanished when I pulled into George’s empty spot, a reminder that I was on my own. Although I’d been given a crash course on the workings of the Mental Health Center, I didn’t know nearly enough to run the place with any authority. Nonetheless, I pulled the heavy door open and began the trek to our gate.

  It was a busy morning in our wing; a long line of patients extended out of Hart’s Island awaiting medical treatment. Two others stood outside a dorm while an officer fussed with keys. One bore a simple, childlike expression and I surmised he was retarded. The other rocked back and forth, an eager look on his face. The officer hollered to his colleague back at the gate, “I got two nuts here who need to go to the barbershop!”

  I winced when I heard it, but this was everyday jailhouse jargon.

  I had just about reached our office, eager to begin the day, when a loud voice stopped me in my tracks. “maa–rryy!”

  A blonde-haired woman in a white shirt—a captain—was furiously headed in my direction. How did she know who I was? More important, what did she want?

  “Are you in charge?” she demanded, adjusting a flashlight in her holster. The nameplate pinned to her shirt pocket read Sikorski.

  “Yes, for the time being I am.”

  “Well, I’m the captain of the Mental Health Center, and I gotta tell you I’m not happy and the security dep’s definitely not happy.”

  “What seems to be the problem?” I asked, a little less assertively than I would have liked.

  “An inmate named San Filippo came in here last night. He’s in the new admissions dorm right now. This guy’s a major security risk! He’s gotta be moved to a cellblock. Right away!”

  Since cells provide higher security than dorms, DOC assigns general population inmates with more serious charges to a cellblock as opposed to a dorm. But Mental Observation Units, which were comprised of both cellblocks and dorms, were under our authority. Especially where suicide was a concern, we weren’t going to place someone under our care into an isolated cell, high-security inmate or not. However, DOC highly resented our discretion in this area and challenged us every step of the way.

  Because of George’s quick departure, I wasn’t prepared for dealing with DOC at this level. Regardless, this was my first challenge as an administrator, and I had to handle it. “I understand your concerns, Captain, and just so you know, our clinical team meets this morning to consider housing placements, and I’ll definitely bring this up.”

  All things considered, I thought that sounded pretty reasonable. Besides, DOC was famous for perennially exaggerating security risks. But Captain Sikorski just rolled her eyes. “There’s nothing wrong with this guy. Nothing! He’s in a gang and just wants to get over. The deputy warden’s not going for this, I can tell you that right now!”

  DOC was always pressuring us to do things their way, but if this inmate was suicidal—gang member or not—and killed himself inside a cell, I’d be the one left to explain why he was in a cell, not her.

  She continued to gape at me, but I didn’t budge, and after a moment she backed off. “Well, all right—I’ll let him know you’re reviewing the case, but he needs to be in a cell,” she emphasized one more time.

  “Well, we’ll see.”

  Inside our office, I immediately found Karen.

  “Oh, Sikorski! She’s always on the warpath. I mean, what are we going to do? Their mission and ours are completely different, and a lot of times they’re right, but we still have to go through our own procedures and not be bullied by them.”

  Karen’s take on it reassured me, and I decided to put the Captain Sikorski matter aside and delve into my morning chores, suddenly grateful for these concrete tasks. As I studied logbooks and calculated the census, I watched the clock, anxious for the start of the clinical meeting.

  At precisely eleven o’clock, I joined Karen and Dr. Marvin Gardiner, the Rikers chief psychiatrist, while we waited for the new admissions team. Gardiner, a longtime Rikers veteran, was beyond retirement years; yet even though he moved slowly, his mind was keen and he was frequently called upon as an expert witness in court situations. Shortly, another psychiatrist and two clinicians made their way in, carrying stacks of charts. Over the weekend, sixteen patients had been referred to us for a higher level of care. The admitted patients basically fell into two categories: the severely depressed (those considered at high risk for suicide), and the “SPIMIs,” those with severe and persistent mental illness such as schizophrenia, bipolar disorder, and dementia.

  One by one, we read through the charts, making preliminary diagnoses and deciding on appropriate housing. Generally speaking, those in the throes of psychosis were better suited for a quiet cell, whereas dorms made more sense for the severely depressed. Finally we reached Jorge San Filippo’s chart. The new admissions team reported that San Filippo said his mother had recently died, that he was facing a lot of time upstate and saw no reason to live. His chart also revealed a history of self-destructive behavior. I relayed Captain Sikorski’s protests to the group, but given his mother’s death and depressed mood when he was interviewed, a transfer to a cell was out of the question. The possibility of suicide needed to be taken seriously. It was the team’s decision that he be transferred to a dorm for closer observation.

  The remainder of the day was uneventful. If Captain Sikorski wanted to know the status of San Filippo, she never called to find out, and I was relieved to get out of the building without any further unpleasant encounters with DOC.

  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.