Supermax Prisons and the Constitution: Liability ... - Supermaxed

xvii■Removal. Implement a process for transfer-escorted out of the unit to receive medical care.■ring inmates out of the ECU if they meet themonitoring system’s criteria for removal.Quality assurance. Consider developing aquality assurance system or audit process asa strategy for addressing legal challenges toscreening and monitoring procedures.ECUs should also be aware of the custody officer’srole in the medical care delivery system andtake steps to avoid inmate complaints related tothat role. Finally, corrections agencies shoulddetermine how privacy regulations under theHealth Insurance Portability and AccountabilityAct (HIPAA) may affect their ECU operations.Executive Summary■ Mental health care. Provide ongoing diagnosisand treatment for mental health conditions.This is the “standard” level of serviceexpected in any prison, and clearly a requirementin the ECU.■ Staffing. Maintain staffing levels in accordancewith the services to be provided.Operating an ECU mental health programshort-handed is an invitation to litigation andcourt intervention.■ Medication. Be aware of legal constraintsconcerning involuntary medication, and haveprocedures in place for medicating inmateswhose serious mental illness presents a threatto themselves and others.Chapter 3. Medical ServicesProviding medical care to ECU inmates involvesoperational challenges and legal concerns,although the constitutional issues are not as greatas those associated with mental health. Staffingrequirements for delivering medical services arelikely to be greater in the ECU than in other units.Confidentiality of medical information is an issuein the ECU, especially when services are deliveredat the cell front. ECUs need enough custodyofficers to avoid delays when inmates must beChapter 4. Other Conditionsof ConfinementWith regard to certain conditions of confinement(personal safety, food and clothing, shelter, sanitation,and exercise), issues in ECUs differ fromissues in general population settings only as amatter of degree. The basic legal test is the same:do the conditions harm the inmate or present aserious risk of substantial harm, and are officialsdeliberately indifferent to that risk. The ECU’svery strict environment may increase the risk ofharm to some inmates (especially the mentally ill)or for some conditions (e.g., exercise).Intensity and duration of exposure may makedefense of allegedly poor conditions more difficultin ECUs than in general prison settings. Ingeneral settings, the effects of poor conditions incells may be mitigated if inmates are out of theircells most of the day to participate in programs,jobs, and other activities. The inmates may beexposed to the poor conditions only a few hoursper day. But ECU inmates rarely leave their cellsand never leave the unit; if poor conditions exist,the inmates’ exposure is constant. Whereas lackof exercise is rarely an issue for inmates in thegeneral population, it is, to some extent, a fact oflife for ECU inmates.