According to Fitzpatrick, the state’s two adult prisons — the other is the medium-security Maine Correctional Center in Windham, where there are 22 solitary-confinement cells — have around 20 mental-health employees covering 1500 inmates, including a psychiatrist and two psychologists at each facility. Most of the employees work for Correctional Medical Services, a for-profit corporation that has figured in a number of inmate-abuse scandals across the country.
Repeated requests by the Phoenix to interview psychologist Maureen Rubano, the state prison’s mental-health director — a state employee — have long gone unanswered.
Maine Medical Association complicity?
Grassian also has a problem with the peer reviewers — teams of doctors from the Maine Medical Association who regularly monitor the medical and psychiatric care provided in the state’s prisons — if they ignore the effects of solitary confinement on inmates.
Gordon Smith, the lawyer who’s the MMA’s executive vice-president, says that while there’s “no doubt” solitary confinement causes mental illness, he couldn’t recall solitary confinement ever being mentioned as a factor in an MMA-reviewed case of prisoner mental illness, and he reads each confidential review. Smith says his group is “not contracted” to look at the effects of isolation. The doctors who go to the prison and inspect the patient charts at random, he says, may not even know if the patient is kept in solitary. Corrections officials admit that the supermax is where many mentally ill inmates wind up, and that more than half of supermax prisoners are seriously mentally ill.
In a peer review there are usually three doctors on a team who for $100 an hour look at about 30 to 40 charts, Smith says. In recent years teams have examined prison adult psychiatric care and adolescent psychiatric care — the latter at the state’s two juvenile prisons. Reviewers talk with the caregivers and medical director of the prison unit involved, but “in 25 years of peer reviews around the state I don’t recall a single instance where a reviewer asked to speak to a patient,” Smith says, although the contract with Corrections allows this. Smith wouldn’t reveal reviewers’ names. The MMA has been doing prison-care review for 10 years.
Despite what appear to be extremely narrow reviews, the MMA’s $20,000 annual contract with Corrections obligates it to provide “reviews of psychiatric and other medical care at the MDOC facilities to ensure the highest quality of care for the prisoners and residents.” Grassian finds absurd any refusal by medical personnel to acknowledge the effects of isolation on prisoners, particularly on the mentally ill: “You just can’t be a doctor and not look at living conditions.”
By many accounts psychiatric patients often go back and forth between the supermax’s more relaxed 32-cell psychiatric-care “pod,” where some inmates get considerable time outside their single-person cells, and its regular solitary-confinement cells. “You don’t have to be a genius” to understand what’s going on in this kind of cycle, Grassian says. Solitary confinement makes the prisoners sick. “It’s ethically so repugnant” for a doctor to ignore the effects of solitary confinement, he adds.
Among some Maine doctors, however, a consciousness is dawning that their colleagues may not be seeing the elephant in the room.
Petzel, the Maine Association of Psychiatric Physicians president, notes that “First, do no harm” is a fundamental principle of medicine. “Turning a blind eye to what’s going on is doing harm,” she says.