Feb. 28, 2012 Testimony

Dr. Raymond Patterson, forensic psychiatrist, continued his direct testimony for the Plaintiffs on Tuesday, Feb. 28, 2012.

Dr. Patterson testified about the comparisons he made between national standards and SCDC conditions, in which S.C. does not fare well.

He testified about a census decline in the numbers of inmates reported to need ICS (Intermediate Care) saying that the numbers no longer reflect normal percentages of ICS patients, which gives the false appearance that a lower number of mental health staff is needed.

Dr. Patterson reported on a large discrepancy between the numbers of female inmates at one prison reported with mental illness (46) versus the number being treated (5). Dr. Patterson explained that mental health care for women at SCDC is inadequate based upon these numbers and his interviews with women at Graham. He also identified a lack of inpatient resources for women, explaining that a lack of available services at the highest level of care is a sign of an inadequate mental health system that that places women in SCDC at substantial risk.

Dr. Patterson also described the environment at SCDC as one where segregation is commonly utilized instead of treatment. He testified that the mentally ill are over-represented in the Special Management Units (SMUs), where mentally ill inmates do not get appropriate care.  “What this means is that we are not putting mentally ill inmates in treatment programs, we are locking them in SMUs.  Special Management Units that are essentially segregated 23-hour lockdown units,” Dr. Patterson said.  Dr. Patterson expressed concern that segregation often contributes to a decline in mental health.

Despite the overwhelming need for better mental health treatment, there is no movement at SCDC toward providing better care.

A former SCDC task force comprised of former and present SCDC heads, Jon Ozmint and Dr. William Byars, among others, stated in 2003 that Gilliam Psychiatric Hospital was in need of replacement: “The current facility is clearly inadequate.” However, instead of moving forward with much-needed services for the mentally ill, plans that SCDC had for new facilities are “on hold.”

In a written statement, Dr. Woolery, a SCDC psychiatrist, said that 40 to 50 percent of the inmates she sees in SMU are actively psychotic and exhibiting symptoms of their illnesses. 

In his testimony, Dr. Patterson said, “The major question is: why are they still in SMU? Why are they not in a place where their illness and symptoms can be treated?”

Dr. Patterson believes that psychiatrists should be monitoring all SMU inmates – not just those that are actively psychotic, to observe them for onset of symptoms. He explained that it is important to check on the quiet inmates – those that staff sometimes calls ‘cell dwellers’ – because those are the ones most at risk of decompensating while in segregation. Isolation is an undisputable risk factor for suicide.

Dr. Patterson does not believe SCDC counselors are qualified to make high-level determinations or recommendations regarding inmates who are decompensating. He said, “There is a mechanism where mental health workers can help corrections officers.  If there is a way to intervene and stop disruptions, you can help corrections manage difficult-to-manage people – we can address the behavior, which can help all.”

He also said that long-term segregation is common for mentally ill inmates at SCDC – one inmate had been in continuously for 2565 consecutive days of segregation - about seven years; another openly psychotic patient (who testified about being able to “see” fire in the room) has been in segregated lockdown for the past twelve years.

Patterson said such long-term segregation can contribute to psychotic disorders, aggression, and suicide. Regardless whether inmates are mentally ill prior to going into segregation, Dr. Patterson testified, segregation complicates their mental condition.

Dr. Patterson described a case in which a schizophrenic inmate's placement in the Supermax Unit resulted in his death.

Dr. Patterson said that communication between security and mental health staff was non-existent in that case. Prior to being placed in Supermax, officials had reported that the inmate was trashing his cell, being loud, and running around naked. Dr. Patterson said he could find no clear reference why the inmate was given no clothing or sheets in Supermax, or why he had not seen his counselor or a psychiatrist in the 11 days he was there, despite policy that requires a counselor assess the inmate under those circumstances daily. The counselor that should have been assessing the inmate stated in a deposition that he had not known his client was in Supermax. The counselor also said that he had never known that inmate to be violent.

Photos were shown of the conditions of the room, which showed blood and dirt throughout it.  Dr. Patterson described the conditions as bleak, filthy and detrimental to anyone’s well-being.

“This is a very tragic example of the serious harm that inmates with mental illness are subjected to,” Dr. Patterson said. “This inmate was transferred to an environment that was bleak and depressing for reasons that were unclear; he was stripped of his basic needs; his mental health counselor was not aware he was there; the SCDC psychiatrists do not go into Supermax."

Dr. Patterson explained that the inmate was still alive when the officers found him, but medical responders waited for inmate workers to come and remove him from the cell before providing medical attention. Several hours passed before he was transferred to an outside hospital, where he died, from a heart attack.

"As a physician, you respond and render service to people in distress… I don’t believe that was done,” Dr. Patterson said.

Another aspect that Dr. Patterson testified was problematic is the disproportionate application of disciplinary sanctions to mentally ill inmates. Despite an available verdict of “Guilty but not Accountable” or GBNA, he said, “It appears there is no impact on the sentencing when the verdict of GBNA is recommended by counselors. The full disciplinary sentence, oftentime in segregation, is commonly imposed regardless. Inmates are sent to lock up even when counselors assess them as not accountable." Dr. Patterson said that although it is unusual in most states to use restraints to prevent self-harm, it is standard practice at SCDC. He also said SCDC does not require staff to get a doctor’s order to use what are essentially medical restraints, which he said is “very concerning to mental health professionals because restraints can do considerable harm and use of them is not considered the ‘least restrictive’ way, in order to reduce the risk of harm.”

“However, at SCDC, the restraint chair is sometimes ordered by counselors and sometimes by corrections staff,” Dr. Patterson said. “This violates the standards because it is not an in-person order, not a doctor’s order, or a written order. SCDC policy allows corrections officials to place inmates in restraints for four hours; then another four hours without evaluation of the behavior.”

Comparing the national standards to SCDC policies, Dr. Patterson said, “Doctor’s orders must contain orders for release, and no specific amount of time is ever ordered. It is always ‘up to’ a limit of time.”

According to Dr. Patterson, once you are in the restraint chair at SCDC – even if you are calm, you remain in the restraints for at least four hours and in some cases up to 12. He said these should be medical decisions, not custody decisions. Later in his testimony, Dr. Patterson was asked, “Are psychiatrists involved in approval of restraint devices?”

“I have seen no evidence of that,” he answered, testifying under oath that one SCDC psychiatrist had told him, “They (security) are running the place. I just get out of the way.”

Three videos involving the use of the restraint chair were then shown.

Two of them were quite graphic and involved cases of inmates being severely injured, one from a self-inflicted cut to a vein in his arm that was bleeding profusely and caused the inmate to go in and out of consciousness; while the other inmate had eviscerated himself, with his intestines bulging outside his abdominal wall. In both cases, the inmates were shown in great distress, but were still strapped down in the restraint chair in ways that made their injuries worse. There were no immediate attempts to administer medical aid. In one case, corrective action was later taken against the staff involved for failing to transport the inmate to a hospital. In the latter case, the forceful tightening of the restraint straps had pushed the inmate’s intestines further out.  A nurse entered and attempted to push the intestines back into his abdomen, without benefit of painkillers or a sterile environment.

Dr. Patterson expressed great concern over the treatment in the videos, pointing out that no medical staff was on duty, the inmate was trembling, which is potentially a sign that he was going into shock. However, no one checked his blood pressure or pulse. Dr. Patterson also pointed out that the bandage, applied by non-medical staff long after the wound was inflicted, had soaked through with blood, and that while there was a great deal of effort to put restraints on the inmate, who was not moving or resisting, there was no effort to stop the bleeding. Instead, his arm was extended downward with restraints, which is the opposite of what should be done to stop bleeding. The inmate was in the chair in this condition for four hours.

Dr. Patterson said, “I have seen a lot of things in 30 years of practice but this is the worst, most outrageous, horrific response … it is the a sign of a broken system.”

The officers in the video could be heard saying that the captain authorized it. When the inmate asks to go over his head, they said there was nothing they could do, that they were "just a first responder."  

When a nurse finally came to check on the inmate, she talked to him through the cell door.  She did not take vital signs or try to determine whether he needed to be sent to a hospital.

Dr. Patterson explained that the memo promising corrective action shows an awareness of what is wrong in this case; but corrective action against one officer does not address the systemic issues. He emphasized that this incident is evidence that the mental health system at SCDC is broken.

“The officers were following instructions of what they are told to do… my opinion is that this is coming from a level much higher up,” he said.

Dr. Patterson described SCDC's mental health program as “crisis reactive."   

“The system is broken,” Dr. Patterson concluded.

Court will resume Wednesday morning at 9 a.m.