Confronting
Confinement
A Report of

the commission on
safety and abuse
in america’s prisons

John J. Gibbons
Nicholas de B. Katzenbach

commission co-chairs

What happens inside jails and prisons does
not stay inside jails and prisons. It comes
home with prisoners after they are released
and with corrections officers at the end of
each day’s shift. We must create safe and
productive conditions of confinement not
only because it is the right thing to do, but
because it influences the safety, health,
and prosperity of us all.

commission staff
executive director
Alexander Busansky

research associate
Andres Rengifo

communications director
Jennifer Trone

research assistants
Michael Corradini
Katherine Kimpel

senior counsel
Jon Wool
counsel
Michela Bowman
operations and outreach
manager
Jenni Trovillion
senior associate
Tina Chiu

fellows
Annie Ulevitch Cantor, Lisa Yedid
Hershman, Leanne Kinsella Taylor

pro bono attorneys
Jason Harman. Arnold & Porter LLP: Stewart
D. Aaron, Keri Arnold, Yue-Han Chow, Katrina
Fischer Kuh, Carolina Musalem R, Glynn K.
Spelliscy, Bryan Earl Webster, Elizabeth
A. Wells. Heller Ehrman LLP: Lisa Cirando,
Christopher Fowler, Lauren McMillen,
Zakiyyah Salim, Jaime Santos. Holland &
Knight LLP: Stephen F. Hanlon, Gretchen N.
Rohr. Morrison Foerster LLP: Obrea
Poindexter. Pillsbury Winthrop Shaw
Pittman LLP: Jennifer Behr, Patrick Hickey.

interns
Chiraag Bains, Gregory Bennett,
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consultants
The Raben Group: Katharine Huffman, Robert
Raben, Julia Sessoms. TSD Communications:
Dwayne Lawler, Ricki Seidman.

website administrator
John McCrory

photographs Andrew Lichtenstein
design Point Five Design: Alissa Levin, Karin Wood

Confronting
Confinement
A Report of

the commission on safety and abuse
in america’s prisons

John J. Gibbons
Nicholas de B. Katzenbach

commission co-chairs
June 2006

Copyright © 2006, Vera Institute of Justice
Supported in part by grants from the Charles River Fund,
Ford Foundation, Fund for New Jersey, JEHT Foundation,
Open Society Institute, Overbrook Foundation, and the
Robert W. Wilson Charitable Trust.
Electronic copies of this report can be downloaded from
the Commission’s website, www.prisoncommission.org.
The Commission on Safety and Abuse in America’s Prisons is
staffed by and funded through the Vera Institute of Justice.
Commission on Safety and Abuse in America’s Prisons
601 Thirteenth Street, N.W.
Suite 1150 South
Washington, D.C. 20005
Vera Institute of Justice
233 Broadway, 12th Floor
New York, NY 10279
www.vera.org

ii

From the Commission Co-Chairs
most americans feel that life in prison and jail does not affect them. it takes
an awful event to remind people that the dangers inside can endanger them: a large-scale riot that
threatens to spill over into the community; a corrections officer who is killed on the job leaving a
family behind; the spread of infectious disease from cell block to neighborhood block. When the
emotional reaction to the awful headline fades, however, we are left only with the sinking feeling
that prison is a problem with no solution. The temptation is always to look away, hoping the troubles
inside the walls will not affect us.
Every day judges send thousands of men and women to jail or prison, but the public knows very
little about the conditions of confinement and whether they are punishing in ways that no judge or
jury ever intended; marked by the experience of rape, gang violence, abuse by officers, infectious disease,
and never-ending solitary confinement. Unless the experience of incarceration becomes real through
the confinement of a loved one or through a family member who works day-to-day in a correctional
facility, jails and prisons and the people inside them are far removed from our daily concerns.
Americans share concerns about struggling schools, dangerous hospitals, and corrupt corporations.
We now talk openly about domestic violence and child abuse because we know there are terrible
consequences for our loved ones, our families, and our communities if we remain silent. Yet there
is a shame and a stigma about incarceration that makes it very difficult to have honest, productive
conversations about what we are doing and the results.
Over the course of a year, the Commission on Safety and Abuse in America’s Prisons tried to
change that by bringing life behind bars fully, vividly into focus and by connecting what happens
inside with the health and safety of our communities. Our inquiry and this report reveal both grave
problems and also good work that fills us with hope. A year ago, a group of individuals with little
in common promised to recommend strategies for operating correctional facilities that serve our
country’s best interests and reflect our highest values. Today, we speak in a single voice about the
problems, our nation’s ability to overcome them, and the risks for all of us if we fail to act. Our nation
has the talent and know-how to transform all of our correctional facilities into institutions that we
can be proud of and rely on to serve the public’s interests, institutions that we would trust to ensure
the safety of someone we love, places of opportunity as well as punishment. We hope you will join us
in this important work.
—John J. Gibbons
Nicholas de B. Katzenbach

iii

“The culture of our prisons virtually
dictates the level of violence that you
will have in them. And if you change that
culture, you will reduce the violence.”
iv

Donald Specter, director of the
Prison Law Office

Contents
Preface	
Commissioners 	
Summary of Findings and Recommendations	

	

6
9
11

i.	 conditions of confinement	18
	
	

1. Prevent Violence	
2. Provide Health Care that Protects Everyone	
3. Limit Segregation	

ii.	 labor and leadership	
	
	

1. Change the Culture and Enhance the Profession	

	

1. Invest in External Oversight	
2. Strengthen Accountability Within the Profession 	
	3. Educate and Involve the Public	

iii.	 oversight and accountability	

iv. knowledge and data	
	

1. Measure Safety and Effectiveness 	

Commission Witnesses	
Works Cited 	
Acknowledgments	

21
38
52

62
65
76
79
88	
95
100
103	

“People are
sentenced to prison
as punishment, not
for punishment . . . .
Corrections
staff should be
the very best
people prisoners
encounter.”
Kathleen Dennehy,
Massachusetts
corrections
commissioner

112
114
118



Preface
A little more than one year ago, a diverse the kinds of productive activities that discourgroup of individuals—respected civic leaders, age violence and make rehabilitation possible,
experienced corrections administrators, scholars, and a culture in many prisons and jails that pits
advocates for the rights of prisoners, law en- staff against prisoners and management against
forcement professionals, members of the reli- staff. There is too little help and hope for the
gious community, and former prisoners—joined individuals we incarcerate and too little respect
together as a national commission to examine and support for the men and women who work
the safety of America’s prisons and jails. What in our prisons and jails. And notwithstanding
we discovered over months of holding pub- these conclusions, we know less about safety
lic hearings, talking individually and in small and abuse in America’s prisons and jails than
groups with a wide range of experts, and review- we should. It is simply not enough to be beting the available research and data is that the ter than we were. We must confront and solve
people who think and care most about safety today’s problems.
and abuse in America’s correctional facilities are
concerned about many of the same problems At the commission’s public hearings in cities
and point to many of the same solutions. This around the country, witnesses testified about the
report is the Commission’s attempt to reflect realities of life behind bars in America—both
that common ground.
good and bad. Lou West recalled a long career
America’s correctional facilities are less turbu- in Missouri as a corrections officer trying to do
lent and deadly violent than they were decades what his job title suggests—“to make right,” as
ago. Many corrections administrators have done he put it. Arthur Wallenstein and Michael Ashe
an admirable job, but steady decreases nationally talked about how providing high quality health
in riots and homicides do not tell us about the care in the jails they run benefits the surroundmuch larger universe of less-than-deadly vio- ing communities. Former gang member Pernell
lence. And beyond physical violence, there are Brown described his return to prison as a counother serious problems that put lives at risk and selor, helping to guide young prisoners away
cause immeasurable suffering.
from gangs and violence. Corrections Secretary
For all of the hard work and achievements of Theodis Beck portrayed an officer corps in North
corrections professionals—most of which the Carolina that is more diverse, better trained, and
public does not hear about—there is still too more professional than ever before.
much violence in America’s prisons and jails, too
Other people who testified before the Commany facilities that are crowded to the breaking mission described devastating events that repoint, too little medical and mental health care, main with them far beyond the walls of any jail
unnecessary uses of solitary confinement and or prison. Through tears, Pearl Beale told us her
other forms of segregation, a desperate need for son Givon was stabbed nine times by another


p r e fa c e

prisoner in a crowded Washington, D.C., jail.
Garrett Cunningham recounted being raped by
a Texas corrections officer twice his size and then
disbelieved and left unprotected by the prison
authorities in whom he confided. And Victoria Wright’s world collapsed, she said, when her
husband of 33 years died in a California prison,
never receiving the heart medication he needed
and kept asking for. These are just a few of the
moving accounts we heard.
Some people would say these are just stories
and would believe the ones that mirror their
own views and experiences. Success stories are
pitted against tragedies, statistics against anecdotes—as if one must choose between data
and personal experiences that can reveal truths
hidden in the numbers. Critics of the daily
headlines are right when they claim that the
most awful events in correctional facilities are
unusual given the innumerable encounters that
take place there every day, but that does not
make them unimportant. Beyond the human
loss, an awful event in a correctional facility can
be a sign of underlying problems that may be
frequent and widespread.
Over the course of the commission’s inquiry,
we consulted hundreds of experts. They include
current and past leaders of state and federal
correctional systems and current and former
prison wardens and jail administrators. We listened equally to labor, seeking to understand
the day-to-day experience of working in prison
and jail. We consulted with experts who monitor prisons, those who advocate for the rights
of the incarcerated, and with current and former prisoners and their families. We visited jails
and prisons across the country. We took advice
from scholars and researchers, religious leaders,
and government officials responsible for making law and policy. We also sought out personal
accounts about life behind bars, receiving more
than a thousand letters, e-mails, and phone calls.
Listening to all of them, we understood over
time how the views they have in common far
outnumber their disagreements.

Drawing on that consensus, this report outlines four broad areas where change can and
must occur: conditions of confinement that directly affect the safety, health, and well-being of
prisoners and staff, the quality of and support for
labor and leadership, oversight of and accountability for what happens behind bars, and the
state of our knowledge and data. In each of these
areas, we offer clear and bold recommendations
that have the potential to change the very nature
of incarceration in this country. It will require an
investment of many dollars to achieve these recommendations, but those dollars will pay dividends for years to come.
Readers looking for a report card on safety
and abuse in all the prisons and jails across
America will not find it in these pages. The
Commission could not walk into every jail and
prison, look around, ask questions, and review
data. We had neither the time nor the resources
for that kind of inquiry, and our work was never
primarily about counting and grading. Sometimes the things we could not do loomed larger
in our minds than what we were accomplishing.
There are entire categories of facilities that we
did not examine: juvenile detention centers and
facilities housing people facing deportation, as
well as facilities run by the military or by Indian
tribes. We did not look specifically at differences
between prisons run by government and those
run by private companies, the impact of an aging
prison population, and the consequences of placing juveniles in adult facilities. Women are the
fastest-growing segment of the prison population and most of them are primary caregivers of
children. We would like to have learned more
about how issues of safety and abuse play out
differently for women prisoners than they do
for men. And finally, the significant differences
between prisons and jails deserve much more attention than we have been able to give them.

The people who
think and care most
about safety and
abuse in America’s
correctional
facilities are
concerned about
many of the same
problems and point
to many of the
same solutions.

There are failing prisons and jails across 
this country, but the American public is also
failing them. As this report makes its way into
the world, readers must remember that many of
p r e fa c e



the biggest so-called prison problems are created outside the gates of any correctional facility.
Congress and state legislatures have passed laws
that dramatically increased prisoner populations
without providing the funding or even the encouragement to confine individuals in safe and
productive environments where they can be appropriately punished and, for the vast majority
who are released, emerge better citizens than
when they entered. With deep personal frustration and disappointment, former Mississippi
Warden Donald Cabana told the Commission,
“In an eight-year period, we doubled our prison
population in the poorest state in America.” As a
society we have focused on putting people away
without understanding the reality of life behind
bars or the consequences when correctional facilities fail—for the mainly poor and minority
communities that live every day with the consequences, and for all of us. We should be astonished by the size of the prisoner population,
troubled by the disproportionate incarceration of
African-Americans and Latinos, and saddened
by the waste of human potential.
It was beyond the scope of our inquiry, and
indeed beyond our mission, to explore how
states and the federal government might sensibly reduce prisoner populations. Yet all that
we studied is touched by, indeed in the grip of,
America’s unprecedented reliance on incarceration. We incarcerate more people and at a higher
rate than any other country in the world. This
reliance bleeds correctional systems of the resources that could be used to rehabilitate rather
than merely to punish and incapacitate; it crowds
whole systems and sometimes individual facilities to the breaking point; and it exacerbates racial and ethnic tensions in America through its
disproportionate impact on African-Americans
and Latinos.
Corrections managers are caught in the
middle: They know that the number of people
incarcerated cannot be an excuse for operating
dangerous and abusive correctional facilities.
Nor can the fact that some of those individuals have committed serious and violent crimes.


p r e fa c e

Approximately half of sentenced prisoners in
state facilities are serving time for a violent offense, and the proportion of violent offenders
in federal facilities is 11 percent. Managers must
overcome the real difficulty of creating safe and
productive correctional environments when their
systems must accommodate so very many people.
In addition to the recommendations in this report, the Commission urges legislators to take
full responsibility for tough-on-crime policies
that have swelled America’s prisons and jails,
filling them with poor, undereducated, and unhealthy individuals. Corrections administrators
must have the resources and support to operate
safe and effective prisons and jails. Better funding
will not guarantee better results, but without it
too many vital reforms will never be attempted.
Corrections administrators also have obligations. In correctional facilities around the country,
there are stark differences and a dehumanizing
disconnection between the people who are incarcerated and the men and women sworn to
protect and supervise them. Those differences
involve race, culture, class, gender, and the difference between rural and urban America. The
best corrections leaders are developing cultural
competence within their institutions, but unless
that practice spreads, America’s prisons and jails
will do more harm than good.
When we began our inquiry in March, 2005,
it felt like the right time for the first national
prison commission in three decades. At 2.2 million, the prisoner population was larger than
ever and still growing, and there were accumulating doubts about the effectiveness and mor­
ality of our country’s approach to confinement.
We needed and were ready to know the state of
safety and abuse in America’s prisons and jails.
Fifteen months later, as we complete our report,
the need for reform feels even more urgent. Millions and millions of lives are at stake. It is time
to do what corrections officer Lou West tries to
do every day: to make things right.

Commissioners
Co-Chairs
The Hon. John J. Gibbons: An attorney in private

practice who argued the groundbreaking Rasul
v. Bush case before the U.S. Supreme Court and
a former Chief Judge of the U.S. Court of
Appeals for the Third Circuit

Nicholas de B. Katzenbach: An attorney in private
practice and former Deputy Attorney General
and Attorney General of the United States
(under Presidents Kennedy and Johnson) who
led the federal government’s efforts to desegregate the American South and chaired the 1967
Commission on Crime in the United States

Members
Salvador Balcorta: CEO of Centro de Salud
Familiar La Fe in El Paso, Texas; Board
Member of the National Council of La Raza;
and a nationally respected Chicano activist for
social justice
Stephen B. Bright: One of the most well-known

advocates in the country for the rights of
prisoners and former Director of the Southern
Center for Human Rights in Atlanta, Georgia, which provides representation to prisoners
in cases involving claims of cruel and unusual
conditions of confinement

Richard G. Dudley, Jr., M.D.: A psychiatrist in pri-

vate practice who is frequently called to provide
expert testimony in criminal and civil cases
around the country about the lasting psychological damage of violence and abuse in prison

James Gilligan, M.D.: A renowned expert on
violence and violence prevention who is
currently Visiting Professor of Psychiatry and
Social Policy at the University of Pennsylvania
and was formerly Director of Mental Health for
the Massachusetts prison system
Saul A. Green: Senior Counsel and member of

Miller Canfield’s Minority Business Practice
Group and former U.S. Attorney for the
Eastern District of Michigan (1994–2001)
Ray Krone: Former prisoner who spent more

than a decade behind bars, some of it on death
row, before DNA testing cleared his name
Mark H. Luttrell: Sheriff of Shelby County
(Memphis), Tennessee, and former warden at
three federal prisons
commissioners



Gary D. Maynard: Director of the Iowa
Department of Corrections and President-Elect
of the American Correctional Association
Marc H. Morial: President and CEO of the

National Urban League and a former Mayor
of New Orleans and Louisiana State Senator
Pat Nolan: President of Prison Fellowship’s
Justice Fellowship and a member of the
National Prison Rape Elimination
Commission, and a former Republican leader
in the California State Assembly who served
25 months in a federal prison on a
racketeering conviction

Stephen T. Rippe: Executive Vice President and

COO of the Protestant Episcopal Cathedral
Foundation and former Major General in the
U.S. Army
Laurie O. Robinson: Director of the University

of Pennsylvania’s Master of Science in
Criminology Program and Chair of the Vera
Institute of Justice Board of Trustees, and
former Assistant Attorney General in charge of
the Office of Justice Programs (1993–2000)
Senator Gloria Romero: California Senate
Majority Leader and Chair of the Senate
Select Committee on the California
Correctional System

10

commissioners

Timothy Ryan: Chief of Corrections for

Orange County, Florida, overseeing one
of the largest jail systems in the United States,
and past President of the American Jail
Association
Margo Schlanger: A leading authority on

prisons and inmate litigation; Professor of
Law at Washington University in St. Louis,
Missouri; and a former attorney in the Civil
Rights Division, Special Litigation Section,
of the U.S. Department of Justice
Frederick A. O. Schwarz, Jr.: Senior Counsel at

Cravath, Swaine & Moore LLP and also at
New York University Law School’s Brennan
Center for Justice

The Hon. William Sessions: A partner in the

Washington, D.C., office of Holland &
Knight LLP, former U.S. District Judge in the
Western District of Texas, and former
Director of the Federal Bureau of Investigation
Hilary O. Shelton: Director of the National

Association for the Advancement of Colored
People, Washington Bureau

Summary of Findings
and Recommendations
what happens inside jails and prisons does not stay inside jails and prisons. it
comes home with prisoners after they are released and with corrections officers at the end of each day’s
shift. When people live and work in facilities that are unsafe, unhealthy, unproductive, or inhumane, they
carry the effects home with them. We must create safe and productive conditions of confinement not only
because it is the right thing to do, but because it influences the safety, health, and prosperity of us all.
The daily count of prisoners in the United States has surpassed 2.2 million. Over the course of a
year, 13.5 million people spend time in jail or prison, and 95 percent of them eventually return to our
communities. Approximately 750,000 men and women work in U.S. correctional facilities as line
officers or other staff. The United States spends more than 60 billion dollars annually on corrections.
Many of those who are incarcerated come from and return to poor African-American and Latino
neighborhoods, and the stability of those communities has an effect on the health and safety of
whole cities and states. If there was ever a time when the public consequences of confinement did
not matter, that time is long gone.
Some of the people confined in our jails and prisons have committed serious and violent crimes.
We can legitimately deprive them of liberty, but we cannot allow anyone who is incarcerated to be
victimized by other prisoners, abused by officers, or neglected by doctors. We must remember that
our prisons and jails are part of the justice system, not apart from it.
There are nearly 5,000 adult prisons and jails in the United States—no two exactly alike. Some
of them are unraveling or barely surviving, while others are succeeding and working in the public’s
interest. To succeed, jail and prison administrators everywhere must confront prisoner rape, gang
violence, the use of excessive force by officers, contagious diseases, a lack of reliable data, and a host
of other problems. Solving these problems takes dedication and dollars. But there is no reason why
health and safety should be limited to only some correctional facilities and no reason why even the
best institutions cannot make a larger contribution to public safety and public health. The findings
and recommendations outlined below, and explored in detail throughout the pages of this report, address the most pressing problems facing corrections today and the reforms that can and must occur.

I. Conditions of Confinement
1.1. violence
Finding: Violence remains a serious problem in America’s prisons and jails.
There is disturbing evidence of individual assaults and patterns of violence in some U.S. prisons and
jails. Corrections officers told the Commission about a near-constant fear of being assaulted. Former
s u m m a ry o f f i n d i n g s a n d r e c o m m e n d at i o n s

11

prisoners recounted gang violence, rape, beatings by officers, and in one large jail, a pattern of illegal
and humiliating strip-searches. Former Florida Warden Ron McAndrew described small groups of
officers operating as “goon squads” to abuse prisoners and intimidate other staff. And in February, 2006,
while the Commission was gathered in Los Angeles for a final hearing, more than a thousand prisoners were attacking each other in the Los Angeles County jails, days of violence that the press described
as riots. At that hearing, California corrections Secretary Roderick Hickman told the Commission:
“Quite frankly, no one denies that violence occurs in prisons and jails in this country.”

Finding: We know which conditions in correctional facilities fuel violence and, therefore,
how to prevent violence.
Violence and abuse are not inevitable. Every correctional facility can provide a safe environment
for prisoners and staff. As Donald Specter, director of the Prison Law Office in California, told the
Commission: “Prisons don’t have to be as dangerous and as violent as they are. The culture of our
prisons virtually dictates the level of violence that you will have in them. And if you change that
culture, you will reduce the violence.”
The majority of prisons and many jails hold more people than they can deal with safely and effectively, creating a degree of disorder and tension almost certain to erupt into violence. Similarly,
few conditions compromise safety more than idleness. But because lawmakers have reduced funding
for programming, prisoners today are largely inactive and unproductive.
prevent violence: recommendations
Highly structured programs are proven to reduce misconduct in correc1. Reduce crowding. States and localities must comtional facilities and also to lower recidivism rates after release. Results
mit to eliminating the crowded conditions that exist
from a Zogby International poll released in April, 2006, show the public’s
in many of the country’s prisons and jails and work
support for protecting public safety through better programming: 87 perwith corrections administrators to set and meet reacent of Americans favor rehabilitative services for prisoners as opposed to
sonable limits on the number of prisoners that facilipunishment only.
ties can safely house.
Decisions about where to house prisoners and how to supervise them
2. Promote productivity and rehabilitation. Invest in
also have an enormous impact on safety. A well-developed system to obprograms that are proven to reduce violence and to
jectively classify prisoners by risk reduces violence among them. So does
change behavior over the long term.
an approach to supervision in which officers are engaging with prisoners
3. Use objective classification and direct supervision.
throughout the day. Yet the best classification and supervision systems still
Incorporate violence prevention in every facility’s funare not commonplace around the country.
damental classification and supervision procedures.
Teaching and modeling non-forceful ways for officers to resolve conflict
4. Use force and non-lethal weaponry only as a last
is crucial because the unnecessary or excessive use of force and weapons
resort.  Dramatically reduce the use of non-lethal
provokes broader violence. Such guidance is especially important given
weapons, restraints, and physical force by using nonthe increasing use of pepper spray, TASER guns, and other weapons that
forceful responses whenever possible, restricting the
can cause serious injuries if used excessively. Former general counsel of
use of weaponry to qualified staff, and eliminating
the Texas prison system, Steve Martin, told the Commission that these
the use of restraints except when necessary to preweapons are often used as a “first strike” response, before other tactics are
vent serious injury to self or others.
considered or attempted.
5. Employ surveillance technology.  Make good use
Finally, the ties with family and community that former prisoners depend
of recording surveillance cameras to monitor the coron after release also promote safety during incarceration. Unfortunately,
rectional environment.
the distance between home and the correctional facility—and a culture in
6. Support community and family bonds.  Reexamsome facilities that does not welcome visitors—makes it hard to maintain
ine where prisons are located and where prisoners
those ties. There are even barriers to maintaining contact by phone when
are assigned, encourage visitation, and implement
the cost of receiving a collect call from someone in prison—much higher
phone call reform.
than in the free world—operates like a tax on poor families.
1 2     s u m m a ry o f f i n d i n g s a n d r e c o m m e n d at i o n s

Finding: We need more reliable measures of violence behind bars than we have today.
Data about deadly violence show decreasing rates nationally of homicide and suicide, but we do
not have equally reliable data about the much larger universe of non-lethal violence. There are prisons and jails that are not collecting or reporting information about assaults: For example, Arkansas,
North Dakota, and South Dakota each reported zero assaults among prisoners statewide in the year
2000. In-depth studies suggest that actual levels of violence among prisoners are at least five times
higher than what even the best administrative records capture. Equally troubling, we have no national
measures of non-lethal physical violence perpetrated by staff against prisoners, despite widespread
agreement that excessive use of force happens. Chief statistician for the federal Bureau of Justice
Statistics Allen Beck told the Commission, “I cannot measure well the level of assaults using administrative records as they exist today.”

1.2. medical care
Finding: High rates of disease and illness among prisoners, coupled
with inadequate funding for correctional health care, endanger prisoners, staff, and the public.
Much of the public dismisses jails and prisons as sealed institutions,
where what happens inside remains inside. In the context of disease and
illness, which travel naturally from one environment to another, that view
is clearly wrong. Left untreated, staph infections and diseases such as tuberculosis, hepatitis C, and HIV directly affect our families, neighborhoods,
and communities.
As a result of poverty, substance abuse, and years of poor health care,
prisoners as a group are much less healthy than average Americans. Every
year, more than 1.5 million people are released from jail and prison carrying a life-threatening contagious disease. At least 350,000 prisoners have a
serious mental illness. Protecting public health and public safety, reducing
human suffering, and limiting the financial cost of untreated illness depends on adequately funded, good quality correctional health care.
Unfortunately, most correctional systems are set up to fail. They have
to care for a sick population on shoestring budgets and with little support from community health-care providers and public health authorities.
Capturing the degree of failure in California, Dr. Joe Goldenson told the
Commission, “There are facilities with four or five thousand people that
only have two or three doctors.” Around the country, some physicians are
operating on a license that restricts their work to correctional facilities
because they are deemed not qualified to provide care in the community.
The public has yet to face the broad and long-term costs of these kinds
of failures.

provide health care that protects
everyone: recommendations

Finding: Medical neglect and the spread of infectious disease are
not inevitable; there are solutions to the health-care dilemmas facing corrections.
Correctional facilities have a tremendous opportunity to provide health
care to people in jail and prison that also protects the public health. But

care rules so that correctional facilities can receive

1. Partner with health providers from the community. Departments of corrections and health providers
from the community should join together in the common project of delivering high-quality health care
that protects prisoners and the public.
2. Build real partnerships within facilities.  Corrections administrators and officers must develop collaborative working relationships with those who provide health care to prisoners.
3. Commit to caring for persons with mental illness.
Legislators and executive branch officials, including
corrections administrators, need to commit adequate
resources to identify and treat mentally ill prisoners
and, simultaneously, to reduce the number of people
with mental illness in prisons and jails.
4. Screen, test, and treat for infectious disease. Every
U.S. prison and jail should screen, test, and treat for infectious diseases under the oversight of public health
authorities and in compliance with national guidelines
and ensure continuity of care upon release.
5. End co-payments for medical care. State legislatures should revoke existing laws that authorize prisoner co-payments for medical care.
6. Extend Medicaid and Medicare to eligible prisoners. Congress should change the Medicaid and Medifederal funds to help cover the costs of providing
health care to eligible prisoners. Until Congress acts,
states should ensure that benefits are available to
people immediately upon release.
s u m m a ry o f f i n d i n g s a n d r e c o m m e n d at i o n s

13

corrections cannot do this alone. Lawmakers must provide adequate funding, and health-care providers from the community must get involved. Together, they can recruit qualified and caring medical
staff who are able to manage contagious and costly diseases. Proper screening and treatment of infectious diseases in correctional facilities makes a difference: Between 1992 and 1998, New York City
reduced tuberculosis cases citywide by 59 percent, and drug-resistant cases by 91 percent, through
this kind of partnership.
Improving correctional health care requires more than partnerships. Many short-term costsaving measures imposed by local, state, and federal legislatures have long-term negative consequences. To drive down the costs, legislators pressure corrections administrators to require prisoners
to make co-payments for their medical care. While co-payments seem reasonable on the surface, they
cost more in the long run by discouraging sick prisoners from seeking care early on, when treatment
is less expensive and more effective and before disease spreads.
Equally troubling, misguided federal law deprives correctional systems of desperately needed
Medicaid and Medicare dollars to fund decent health care. Many people in prison and jail qualify for
these federal benefits and lose them when they are incarcerated. Just like any other community healthcare provider, correctional agencies should be reimbursed for the cost of providing health services to
people who are Medicaid and Medicare eligible. Finally, along with committing more funds to care
for mentally ill prisoners, states and counties need to expand treatment in the community. Our jails
and prisons should not function as mental institutions.

1.3. segregation
Finding: The increasing use of high-security segregation is counter-productive, often causing violence inside facilities and contributing to recidivism after release.
Separating dangerous or vulnerable individuals from the general prison
limit segregation: recommendations
population is part of running a safe correctional facility. In some systems
1. Make segregation a last resort and a more producaround the country, however, the drive for safety, coupled with public
tive form of confinement, and stop releasing people
demand for tough punishment, has had perverse effects: Prisoners who
directly from segregation to the streets. Tighten adshould be housed at safe distances from particular individuals or groups of
missions criteria and safely transition people out of
prisoners end up locked in their cells 23 hours a day, every day, with little
segregation as soon as possible. And go further: To
opportunity to be productive and prepare for release. People who pose no
the extent that safety allows, give prisoners in segre­
real threat to anyone and also those who are mentally ill are languishing
gation opportunities to fully engage in treatment,
for months or years in high-security units and “supermax” prisons. In some
work, study, and other productive activities, and to
places, the environment is so severe that people end up completely isofeel part of a community.
lated, confined in constantly bright or constantly dim spaces without any
2. End conditions of isolation.  Ensure that segremeaningful human contact—torturous conditions that are proven to cause
gated prisoners have regular and meaningful human
mental deterioration. Prisoners often are released directly from solitary
contact and are free from extreme physical conditions
confinement and other high-security units directly to the streets, despite
that cause lasting harm.
the clear dangers of doing so.
3. Protect mentally ill prisoners.  Prisoners with a
Between 1995 and 2000, the growth rate in the number of people
mental illness that would make them particularly vulhoused in segregation far outpaced the growth rate of the prison populanerable to conditions in segregation must be housed
tion overall: 40 percent compared to 28 percent. As lawyer, scholar, and
in secure therapeutic units. Facilities need rigorous
prison monitor Fred Cohen told the Commission, segregation is now
screening and assessment tools to ensure the proper
a “regular part of the rhythm of prison life.” There is troubling evidence
treatment of prisoners who are both mentally ill and
that the distress of living and working in this environment actually causes
difficult to control.
violence between staff and prisoners. And the consequences are broader
1 4     s u m m a ry o f f i n d i n g s a n d r e c o m m e n d at i o n s

than that: Housing a prisoner in segregation can be twice as costly as other forms of confinement,
and the misuse of segregation works against the process of rehabilitating people, thereby threatening public safety.

II. Labor and Leadership
Finding: Better safety inside prisons and jails depends on changing the institutional culture,
which cannot be accomplished without enhancing the corrections profession at all levels.
Most corrections professionals work under extremely difficult circumstances to maintain safety
and help prisoners improve their lives. But because the exercise of power is a defining characteristic of
correctional facilities, there is constant potential for abuse. In the worst cases, the institutional culture
can devolve into one where, in the words of prison chaplain Sister Antonia Maguire, prisoners are
treated like “animals, without souls, who deserve whatever they get.” Cultivating a positive culture
inside our correctional facilities is more than a “feel good” idea. As former Minnesota Warden James
Bruton wrote, “Security and control—given necessities in a prison environment—only become a
reality when dignity and respect are inherent in the process.”
Today there are efforts to improve the underlying culture of prisons and jails in places as far apart
as Oregon, Arizona, Massachusetts, and Maryland. Corrections administrators leading those reforms
understand that an “us versus them” mentality endangers prisoners and staff and, over time, harms
the families and communities to which prisoners and staff belong. “We’re moving away from having
that feeling of being safe when offenders are all locked up, to one where we’re actually safer because
we have inmates out of their cells, involved in something hopeful and productive,” explained Mary
Livers, Maryland’s deputy secretary for operations.
Efforts at culture change cannot succeed and bear fruit, however, without recruiting and retaining a highly qualified officer corps and great corchange the culture and enhance
the profession: recommendations
rections leaders. All too often, that is not the case. The rate of turnover
among officers averages 16 percent annually—and is higher where the pay
1. Promote a culture of mutual respect. Create a posiis lower. Directors of systems remain on the job for no more than three
tive culture in jails and prisons grounded in an ethic
years on average, and their rapid turnover destabilizes entire systems.
of respectful behavior and interpersonal communicaState and local governments must improve pay for officers and find
tion that benefits prisoners and staff.
2. Recruit and retain a qualified corps of officers.
other ways to develop the labor force at all levels. Training for officers
must improve so that they are better prepared to interact effectively with
Enact changes at the state and local levels to adprisoners from diverse backgrounds. The skills and capacities of lieutenants,
vance the recruitment and retention of a high quality,
captains, and wardens—staff who have the greatest influence on the culture
diverse workforce and otherwise further the profesof prisons and jails day to day—must be developed. And governors and
sionalism of the workforce.
3. Support today’s leaders and cultivate the next
local officials must hire the best qualified professionals to lead correctional
systems and give them the freedom and resources to do the job well.
generation.  Governors and local executives must
hire the most qualified leaders and support them po-

III. Oversight and Accountability

litically and professionally, and corrections administrators must, in turn, use their positions to promote
healthy and safe prisons and jails. Equally important,

Finding:  Most correctional facilities are surrounded by more than
physical walls; they are walled off from external monitoring and
public scrutiny to a degree inconsistent with the responsibility of
public institutions.

we must develop the skills and capacities of middlelevel managers, who play a large role in running safe
facilities and are poised to become the next generation of senior leaders.
s u m m a ry o f f i n d i n g s a n d r e c o m m e n d at i o n s

15

All public institutions, from hospitals to schools, need and benefit from strong oversight. Citizens
demand it because they understand what is at stake if these institutions fail. Prisons and jails should
be no exception. They are directly responsible for the health and safety of millions of people every
year, and what happens in correctional facilities has a significant impact on the health and safety of
our communities.
Corrections leaders work hard to oversee their own institutions and hold themselves accountable,
but their vital efforts are not sufficient and cannot substitute for external forms of oversight. Former
Oklahoma Warden Jack Cowley cautioned, “When we are not held accountable, the culture inside
the prisons becomes a place that is so foreign to the culture of the real world that we develop our own
way of doing things.” Or as U.S. Department of Justice Inspector General Glenn Fine, who oversees
all federal prisons, told the Commission, “There is tremendous pressure within an institution to keep
quiet.” Despite increased professionalism within the field of corrections, there remains resistance to
scrutiny by “outsiders” that must be overcome.
The most important mechanism for overseeing corrections is independent inspection and monitoring. Every U.S. prison and jail should be monitored by an independent government body, sufficiently
empowered and funded to regularly inspect conditions of confinement and
increase oversight and
report findings to lawmakers and the public. Today, this is the case in only
accountability: recommendations
a few states and localities. While independence is a crucial feature, the re1. Demand independent oversight. Every state should
lationship with corrections should be collaborative: insiders and outsiders
create an independent agency to monitor prisons and
working together to ensure safe and effective facilities.
jails.
The federal courts also have an important role to play. Federal civil rights
2. Build national non-governmental oversight.  Crelitigation ushered in life-saving reforms over the past 30 years. Several
ate a national non-governmental organization capamisguided provisions of the Prison Litigation Reform Act enacted in 1996
ble of inspecting prisons and jails at the invitation of
must be changed so that the federal courts can deliver justice to individual
corrections administrators.
prisoners who are victims of rape, excessive use of force, and gross medical
3. Reinvigorate investigation and enforcement.  Exneglect, and compel reform in facilities where prisoners and staff are in
pand the investigation and enforcement activities of
danger. Equally important, the U.S. Department of Justice must step up
the U.S. Department of Justice and build similar caefforts to monitor correctional facilities and, when appropriate, bring civil
pacity in the states.
or criminal actions in response to abusive conditions. States should develop
4. Increase access to the courts by reforming the
similar capacities. Finally, every prison and jail should allow the press to do
PLRA. Congress should narrow the scope of the Prisits job; invite lawmakers, judges, and citizens to visit facilities; and work in
on Litigation Reform Act.
other ways to inform the public about life behind bars.
5. Monitor practice not just policy. Ensure that American Correctional Association accreditation more accurately reflects practice as well as policy.
6. Strengthen professional standards.  Improve and
support American Correctional Association standards.
7. Develop meaningful internal complaint systems.
Corrections managers should strengthen the systems that allow them to listen to those who live and
work in prisons and jails.
8. Encourage visits to facilities. Create opportunities
for individual citizens and organized groups, including judges and lawmakers, to visit facilities.
9. Strive for transparency. Ensure media access to facilities, to prisoners, and to correctional data.
1 6     s u m m a ry o f f i n d i n g s a n d r e c o m m e n d at i o n s

Finding: Internal oversight and accountability is no less crucial than
monitoring from the outside. We need to strengthen the mechanisms that exist and make more use of them.
The American Correctional Association (ACA) has developed a solid
set of standards governing all aspects of correctional operations and provides a process whereby facilities can become accredited by complying
with the standards. Yet today only a tiny fraction of the nation’s jails and
fewer than half of America’s prisons are accredited. Every prison and jail
should be accredited, and the ACA should raise some standards—pushing institutions to excel beyond acceptable practice to good practice—and
continue to strengthen the accreditation process.
Internal oversight also depends on listening to those who are incarcerated and to the officers who work the tiers and pods. No director, warden,

or shift commander alone can know all he or she needs to know. In many correctional facilities,
there are inadequate, sometimes wholly meaningless, systems for receiving and responding to
prisoners’grievances and reports by staff about misconduct, and there are failures to safeguard from
retaliation those who speak out. Corrections administrators must encourage prisoners and staff to
voice their concerns and then protect them.

IV. Knowledge and Data
Finding: Uniform nationwide reporting on safety and abuse in correctional facilities is essential. Incomplete and unreliable information currently hampers the ability of corrections
leaders, legislators, and the public to make sound decisions about prisons and jails.
All correctional facilities should be required to record and report to the federal government essential information about safety and health inside facilities. The data we have today is incomplete
and unreliable in ways that make it impossible to get a complete picture of safety and abuse in
correctional facilities, compare levels of safety in systems and facilities across the country, or dependably track trends over time within a single state or local system. There must be public demand
for more and better information about the health and safety of our correctional facilities. Without
it corrections administrators cannot make the best management decisions, legislators cannot make
the best policy decisions, and the public has no way to judge whether those decisions protect or
hurt the community.
The federal Bureau of Justice Statistics, the Association of State Correctional Administrators, and
others are working to standardize the data collection process. Congress should pass legislation that
builds on those efforts by funding uniform, nationwide reporting, and state legislatures should mandate compliance with the national reporting requirements. Congress also should enact legislation
that provides incentives for states to track the success of former prisoners, using the most sophisticated measures, and then analyze the outcomes alongside conditions of confinement, including levels
of violence. This is a tremendously difficult task, but it is work that policymakers should embrace as
it will contribute directly to public safety.
Finally, we cannot hold corrections administrators accountable for the safety of prisoners and
staff, and for public safety, if we do not provide the resources necessary to
effectively manage their facilities. Every criminal statute, every sentencing
improve knowledge and data:
recommendations
policy, and every policy related to probation and parole has consequences
for the conditions inside our prisons and jails and for the health of com1. Develop nationwide reporting. Federal legislation
munities. Legislators should be required to confront the potential conseshould support meaningful data collection, and states
quences of the laws they are considering and publish impact statements
and localities should fully commit to this project.
2. Fund a national effort to learn how prisons and
before voting.
jails can make a larger contribution to public safety.

In Conclusion

The federal government and states should invest in
developing knowledge about the link between safe,
well-run correctional facilities and public safety.

We all bear responsibility for creating correctional institutions that are
safe, humane, and productive. With so much at stake for our citizens’
health and safety, with so many people directly affected by the conditions
in our prisons and jails, this is the moment to confront confinement in
the United States.

3. Require correctional impact statements. The federal
government and states should mandate that an impact
statement accompany all proposed legislation that
would change the size, demographics, or other pertinent characteristics of prison and jail populations.
s u m m a ry o f f i n d i n g s a n d r e c o m m e n d at i o n s

17

“There are offenders who need to be
controlled at all times, but they still
need contact with other people. They
still need to feel like human beings.”
James Bruton, former Minnesota warden

I. Conditions of
	 Confinement
the conditions of confinement in our 
jails and prisons should concern everyone. How
we treat the people we incarcerate and whether
we protect and support the staff has consequences
that reach beyond the walls of every institution.
Staff return to their families at the end of a shift,
and 95 percent of prisoners are eventually released,

“Quite frankly, no
one denies that
violence occurs in
prisons and jails in
this country.”
Roderick Hickman,
California
corrections secretary

most of them to poor and minority communities
where crime rates are high and employment rates
are low. § We now incarcerate an estimated 13.5
million Americans over the course of a year and
employ 750,000 people in our prisons and jails. We
may choose to punish criminals through the use
of incarceration, but no place of confinement can
ever be entirely separate from the larger society.
Just as we make choices about appropriate forms
of punishment, we must establish appropriate
conditions of confinement. Millions and millions
conditions of confinement

19

of people are changed by their experience of prison and jail, and the public
has a role in determining whether they return home to their families and
their communities and to all of us marked by exposure to violence and
abuse, disease and trauma, or whether they are safe and healthy inside the
walls, and perhaps changed for the better.
There are many conditions, physical and social, that determine whether
correctional facilities are safe and healthy or places where violence, abuse,
and degradation reign. Among them, three are particularly influential: the
level of violence, the quality of medical and mental health care, and the
prevalence and nature of segregation.
Violence and abuse, and an institutional culture that condones abuse, are
truly deadly to the purposes of a correctional facility. There are prisons and
jails where officers too often use weapons and force instead of words and
where prisoners lash out at each other and at officers. But this is not the fate
of all correctional facilities. In some institutions, officers maintain safety for
everyone—in part by directly engaging with prisoners and, in some cases,
bridging race, culture, and class differences to make those connections.
If prisoners are sick and uncared for, they suffer, and so does the public
health. Correctional facilities are struggling to meet the many healthcare needs of prisoners and to protect staff. In failing institutions, care is
entrusted to unqualified medical staff, and officers create barriers to care
instead of helping to identify sick prisoners. But in facilities that have the
funding and leadership to provide good health care, we see real efforts to
help individuals recover from physical and mental illness and to control the
spread of communicable disease.
Finally, we cannot promote safety or rehabilitation if we confine prisoners in high-security “segregation” units where they have no opportunity
to interact with others or to take responsibility for their lives. There are
entire supermax prisons built on this model, where people live in isolation,
an environment that is damaging to staff and prisoners, and to the public
when prisoners are released. Yet in other facilities, administrators control
even dangerous prisoners without stripping them of all human connections and dignity.
There are nearly five thousand adult prisons and jails in the United
States—no two exactly alike. Some of them are unraveling or barely surviving, while others are succeeding by preventing violence, promoting health,
and using segregation only as a last resort. In this first section of our report,
we explore these three crucial struggles and their influence on the nature of
confinement in America today and its impact on society.

20

conditions of confinement

Prevent Violence

the ability of a correctional facility to protect prisoners
and staff from physical harm is a fundamental measure of the success or
failure of that institution—day to day within the walls, and over time as
men and women carry their prison experience home to their families and
neighborhoods. While the connections between safety inside correctional
facilities and public safety broadly defined are complex, there is no question
that efforts to cultivate a nonviolent correctional environment pay off in
the community in a multitude of ways.
Corrections administrators do not want to run violent facilities. When
individuals under their care are seriously hurt, administrators are likely to
experience those breaches in safety as personal and professional failures.
The extent of rape, assault, excessive use of force, and other types of violence in America’s prisons and jails remains one of the most highly charged
and debated aspects of the profession. Emotions run high because lives, careers, and reputations are at stake, and because assessing levels of violence
in America’s prisons and jails is a very difficult thing to do.
During the Commission’s hearings, several corrections professionals,
experts working outside the profession, and former prisoners testified
about violent acts and patterns of violence in some U.S. prisons and
jails. Speaking about the threats staff and administrators face, former
Mississippi Warden Donald Cabana said, “I’ve had to negotiate no
fewer than eight hostage situations, deal with riots, et cetera.” “I couldn’t
protect [the women] from being sexually preyed upon,” former New
York Superintendent Elaine Lord told the Commission. Former New
Jersey prisoner Thomas Farrow described nighttime beatings where
officers targeted certain prisoners. Ron McAndrew, former warden of
the maximum security prison in Florida told the Commission about
“goon squads,” small groups of violent officers beyond even his control,
and commented that the abuse of prisoners was a problem throughout
the Florida Department of Corrections. Over the course of the Commission’s final hearing in February, 2006, in Los Angeles, while more
than a thousand prisoners were attacking each other in the county jails,
California corrections Secretary Roderick Hickman told the Commission: “Quite frankly, no one denies that violence occurs in prisons and
jails in this country.”

recommendations
1.	 Reduce crowding. 
2.	 Promote productivity and rehabilitation.
3.	 Use objective classification and 	
direct supervision.
4.	 Use force, non-lethal weaponry, and
restraints only as a last resort. 
5.	 Employ surveillance technology.
6.	 Support community and family bonds.

prevent violence

21

“If you put poor,
underprivileged young
men together in a large
institution without
anything meaningful to
do all day, there will be
violence. If that institution
is overcrowded, there
will be more violence. If
that institution is badly
managed . . . [including]
poor mental health
care, there will be more
violence.”
Donald Specter, director of the
Prison Law Office in California

2 2     c o n d i t i o n s o f c o n f i n e m e n t

These are just five accounts among many. A look at news headlines
published during the first two weeks in April, 2006, reveals 20 stories of
violence in 13 different states. The headlines, which are collected daily by
the Corrections and Criminal Justice Coalition, a corrections labor group,
include “Inmate Attacks Nurse, Two Deputies, in County Jail” (Florida),
“Former Fitchburg Prison Guards Charged with Sex Assault” (Wisconsin),
“Prisoner Killed in Dona Ana County Jail” (New Mexico), and “Prison System Takes Steps to Crack Down on Inmate Sexual Violence” (Alabama).
The Commission closely examined the research on violence and the
data collected nationally. We know that prisons are less deadly than they
were decades ago: Nationally, reported rates of homicide and suicide have
decreased dramatically over the past three decades (Useem and Piehl 2005).
Deaths in custody are relatively easy to count accurately, but to precisely
measure the much larger universe of non-lethal violence is practically impossible given how we collect data today. In a section of this chapter, we
explore flaws and gaps in the available data in a way that we hope encourages better and more complete measures of violence in the future. Toward
the end of this report, on page 101, we begin a larger discussion of how to
improve data collection and knowledge.
While persistent accounts of violence in U.S. correctional facilities are
troubling and its prevalence remains unclear, there is a great deal of agreement about what causes violence and how to prevent it. Donald Specter,
Director of the Prison Law Office in California, summarized the driving
factors of violence in his testimony to the Commission: “If you put poor,
underprivileged young men together in a large institution without anything
meaningful to do all day, there will be violence. If that institution is overcrowded, there will be more violence. If that institution is badly managed . . .
[including] poor mental health care, there will be more violence. And if
there is inadequate supervision of the staff, if there is ineffective discipline,
if there is a code of silence, if there are inadequate investigations, there will
be even more violence.” In a review of the literature and empirical evidence
on the causes of prison violence, Professor James Byrne pointed to staffing levels, ineffective classification and placement decisions, poor facility
design, prisoners with histories of violence, and the absence of autonomy
among prisoners (Byrne et al. 2005). And Massachusetts Commissioner
Kathleen Dennehy told the Commission about the corrosive effects of a
code of silence among officers: that it reinforces negative behavior among
prisoners and increases violence overall.
Racial, ethnic, and socio-economic differences among prisoners and
between prisoners and staff also play a role, albeit a more complex one
than many people understand. Jack Beck, an attorney and director of the
Prison Visiting Project at the Correctional Association of New York, described preliminary results of a study being conducted by his organization
on violence in the New York prison system. He explained that despite the
fact that the majority of the prisoners in New York State come from the
same New York City neighborhoods, populated mainly by poor African-

Americans and Latinos, prisoners report markedly different levels of gang
violence in different facilities. The study’s results to date suggest that in
facilities where tensions generally run high, gang violence is reported to
be a greater problem. Similarly, there appears to be a strong correlation
between reported levels of violence by staff against prisoners and violence
among prisoners.
This unusual study helps to show how a culture of violence can develop
behind bars and how it can be prevented. Beck added that the lowest levels
of tension and violence seem to exist in facilities where staff clearly follow
policies, where there is meaningful communication between prisoners and
staff, and where prisoners feel respected. All of these qualities flow from
good leadership. In facilities that are culturally diverse and where there
are stark racial, ethnic, and class differences between staff and prisoners,
a culture of respect requires having staff who understand and appreciate
cultural differences. As former prisoner and City University of New York
policy expert Eddie Ellis testified, “The race, class question, I think, underlies many of the tensions that exist in the prisons.”
Witness after witness told the Commission that violence in prisons and
jails is not inevitable. “Prisons don’t have to be as dangerous and as violent
as they are,” Donald Specter said. “The culture of our prisons virtually
dictates the level of violence that you will have in them. And if you change
that culture, you will reduce the violence.” Every recommendation in this
report is offered because of its potential to promote health and safety
within the walls and beyond, into the surrounding community. Drawing
on research findings and the wisdom of individuals with long experience
in corrections, this chapter offers six practical recommendations focused
specifically on preventing violence in America’s prisons and jails.

1

Reduce crowding.  States and localities must commit to
eliminating the crowded conditions that exist in many of the
country’s prisons and jails and work with corrections administrators
to set and meet reasonable limits on the number of prisoners that
facilities can safely house.
Crowding, and the tremendous increase in the prisoner population that
underlies it, fuels violence. Crowding severely limits or eliminates the ability of prisoners to be productive, which can leave them feeling hopeless;
pushes officers to rely on forceful means of control rather than communication, and makes it harder to classify and assign prisoners safely and identify the dangerously mentally ill. Services ranging from nutrition to dental
and medical care are affected by crowding. Every vital service is diluted
or made operationally impossible. And then there is simply the excessive
noise, heat, and tension. This is fertile ground for violence. California corrections Secretary Roderick Hickman listed overcrowding first among the
significant factors contributing to violence. Little surprise, since he had the
burden of managing a prison system that confines twice as many people as
the facilities were designed to house (Harrison and Beck 2005).
prevent violence

23

violence: the numbers and beyond
A Decades-Long Decline 	
in Deadly Violence

Data on Non-Deadly Violence: 	
Too Flawed to Draw Definitive Conclusions

Data collected by the Bureau of Justice Statistics of the

BJS has made significant progress in improving the validity, reliability, and compre-

U.S. Department of Justice (BJS) on deaths in custody

hensiveness of the data on violence, but there are still significant weaknesses and

show a downward trend nationally in recorded levels

blind spots. National data on assaults, in particular, are considered by BJS’s chief

of homicide and suicide in state prisons and local

statistician, Allen Beck, to be unreliable. “The level of assaults is simply not known.

jails. This decline occurred even as the U.S. prisoner

I cannot measure well the level of assaults using administrative records as they exist

population increased more than tenfold. Homicide rates

today,” Beck told the Commission.

in state prisons decreased dramatically from a 20-year

The imprecision and unreliability of the data on assaults stems in part from the

high of 54 homicides per 100,000 prisoners in 1980 to

fact that state and local systems have vastly different commitments to recording

4 per 100,000 in 2002. During the same period, suicide

violence, define assaults differently, and are not consistent over time in what they

rates decreased from 34 per 100,000 prisoners to 14 per

record and report to the federal government. While there is at least an effort to collect

100,000. In local jails, reported homicide rates declined

administrative data on assaults in prison, there is no effort to collect parallel data

from 5 per 100,000 prisoners in 1983 to 3 per 100,000

for jails nationwide. Perhaps the biggest blind spot: There are no national measures

in 2002, and the suicide rate in 2002 was less than

of physical violence and excessive use of force by staff against prisoners, including

half the rate reported in 1983 (47 per 100,000 prisoners

the inappropriate use of restraints and non-lethal weapons. And these considerable

compared with 129 per 100,000) (Mumola 2005).

weaknesses are just part of the problem.

In the most recent published national data, for

Measuring levels of violence and victimization has always challenged social

2002, there were a total of 68 homicides and 482

science researchers. It is particularly difficult to measure violence between prisoners.

suicides in state prisons and local jails, and 84 deaths

Administrative records are believed to significantly underrepresent the actual numbers.

occurring for “other/unknown” reasons (Mumola

Studies have found that prisoners dismiss the value of reporting violence or attach

2005). Deaths by “positional asphyxiation,” often

stigma to those who do report (Edgar and O’Donnell 1998). Researchers have found

the result of improper physical force or mechanical

large disparities between levels of violence captured in official records compared

restraints, are counted among “other” deaths. The

with reports by prisoners and staff about victimization. To researchers, prisoners

number of fatalities, however, is just a small part of

report assaults at a rate five times higher than the number recorded by correctional

the violence behind bars.

authorities (Fuller and Orsagh 1977, Cooley 1993).
The weaknesses and gaps in administrative data reported to the federal
government mean that we cannot pinpoint actual levels of violence in U.S.

Arkansas, North Dakota, and South Dakota reported zero assaults
among prisoners statewide in 2000. Pennsylvania, with a prisoner
population of 36,000, reported just 17 prisoner-on-prisoner assaults.
correctional facilities or reliably assess trends over time. All we have are rough
indicators. The most recent data available are from the year 2000. Over the course
of a year, there were 34,355 reported assaults among prisoners in state and federal
facilities and 17,952 reported assaults by prisoners against staff (Stephan and
Karberg 2003). Additionally, the first wave of data collection on sexual assault
mandated by the 2003 Prison Rape Elimination Act—a gathering of administrative
data from 1,840 adult prisons and jails nationwide in 2004—documented 4,252
recorded allegations of sexual assault, misconduct, and harassment by prisoners
and staff (Beck and Hughes 2005).
2 4     c o n d i t i o n s o f c o n f i n e m e n t

Looking Beyond National Assault Numbers 	
Reveals Problems in the Data
A look beyond national measures of assaults to the 1995
and 2000 state- and facility-level data that inform those

Assaults by Prisoners: Questionable Data

aggregate numbers raises serious questions about the
reliability of the reported levels of violence in state
prisons. There are at least three reasons for doubt: In
some states, a number of facilities are not reporting
assault data; in some states, the number of assaults
reported is improbably low; and looking at the rate of
assault, the variation between states and changes within
states over time are inexplicably large.
In 13 states, 10 percent or more of the prisons failed to
report assaults by prisoners against prisoners or against
staff in both 1995 and 2000. Moreover, some states had
even higher levels of non-reporting: For example, none
of North Dakota’s facilities reported prisoner-on-prisoner
assaults in 1995, and a quarter of Ohio’s facilities did not
report that data in 2000. When data is missing, BJS has to
estimate the number of assaults. It is generally accepted
that estimating more than 10 percent of any single type
of data makes the resulting measure unreliable.
Another indicator of unreliability is the extremely
small numbers of assaults reported in many prisons.

10 percent or more of the state’s
prisons failed to report data on
assaults by prisoners against
prisoners or by prisoners against
staff in both 1995 and 2000

50 percent or more of the state’s
prisons reported zero assaults
against prisoners or staff
in 1995 or 2000
States in which both of the
above occurred

source: bureau of justice statistics

Arkansas, North Dakota, and South Dakota reported zero assaults among prisoners
statewide in 2000. In 26 states, 50 percent or more of prisons reported zero assaults

Better Measures are Needed

against prisoners or staff in 1995 or 2000. And several large state systems reported

We need uniform definitions of non-lethal violence

very low total assault numbers: In 2000, Pennsylvania reported just 17 prisoner-on-

and standardized reporting of it (see Knowledge and

prisoner assaults among a prisoner population of 36,000, and Virginia, with 30,000

Data on p. 101). We also need additional mechanisms

prisoners, reported 61 assaults against prisoners statewide.

for measuring violence and victimization. BJS reaches

Finally, a look at reported rates of assault in state prisons raises doubts. In 2000,

its conclusions about trends in violence based solely

the great variation in reported statewide rates of prisoner-on-prisoner assaults is

on administrative records of rule violations, even

questionable: For example, Louisiana reported 131 per 1,000 prisoners, California

though the agency regularly surveys men and women

reported 44 per 1,000, and Florida reported only 5 per 1,000. And the change in the

in prison. BJS should ask more questions about vio-

reported rates between 1995 and 2000 was also often questionably large: In two

lence and make an effort to ask the same questions

states, the rate of prisoner-on-prisoner assault declined by 100 percent, that is to

every time the agency surveys prisoners in order to

zero. And in nine states the rates increased by more than 100 percent. At the extreme:

capture trends over time. Doubts about the reliability

Georgia’s rate went from 0.13 assaults per 1,000 prisoners in 1995 to 57 per 1,000 in

of administrative records to fully capture levels of sex-

2000; Utah’s increased from 6 per 1,000 to 62 per 1,000 over that period. (BJS 2000

ual assault led BJS to carefully construct a survey of

Census data set, Beck and Harrison 2001).

current and former prisoners, which it is now testing.
This survey should encourage and guide the development of a broader survey that captures other forms of
non-lethal violence.
prevent violence

25

The largest jail system in California and the largest nationwide—operated by the Los Angeles County Sheriff ’s Department—is also extremely
crowded. During the week of the Commission’s final hearing, in February,
2006, in Los Angeles, there was ongoing violence in the jails that claimed
two lives and injured more than 100 prisoners (del Barco 2006). Sheriff Lee
Baca and others attributed the violence to racial tensions and gangs in the
jails and in the community. Jody Kent, who coordinates a court-directed
monitoring program within the jails, disagreed with this limited characterization when she testified before the Commission. She argued that
interracial violence was in large part a reaction to institutional problems,
particularly crowding, which had created stressful living conditions and
a near total absence of programming and productive activities. Similarly,
in describing Alabama’s Julia Tutwiler Prison for Women, a federal judge
said that severe crowding can make a facility a “ticking time bomb,” where
explosions of violence are inevitable (Birmingham News 2002).
Law professor and prison consultant VinOvercrowding and Violence in 	
cent Nathan described crowded facilities with
Alabama’s Prison for Women
“broken toilets, compromised heating and venThe Julia Tutwiler Prison for Women in Wetumpka, Alabama, was built in 1942
tilation systems, peeling paint, broken windows,
to house 364 women. By 2002, it was home to more than 1,000 women. When a
mold-covered showers, generally filthy condifederal lawsuit was brought in 2002 to address extreme crowding, violence was
tions, and other physical breakdowns [that]
one of the primary concerns. The facility did not have the capacity to separate
contribute to tension.” Under these conditions,
prisoners who were dangerous to one another; it did not have the resources or
he explained, it is more difficult to maintain
capacity to safely care for and separately house prisoners with mental illness
order and lawful behavior, and the level of inand those with serious diseases; and it was too crowded and underresourced to
mate and staff safety “plummets.” Nathan conprovide programming, so prisoners were spending endless idle hours in brutally
cluded that crowded facilities are “inhumane,
hot dormitories crammed so full of beds and bodies that officers could not monitor
unsafe, idle, and hopeless, precisely the opposite
and control them.
of what conscientious prison administrators are
In July, 2002, an officer was severely beaten while working alone inside one of
attempting to accomplish.”
the crowded dorms. At that time there were, on average, only 12 officers at any
Conservative measures show a decline in
given time responsible for supervising more than 1,000 prisoners—and at one
crowding nationally among state prisons—from
point, there were as few as nine officers on duty. In 2002, 91 assaults had been
114 percent of their highest, “operational” capacity
recorded by December, making Alabama’s only women’s prison the most violent
in 1995 to 99 percent in 2004. A less conservative
prison in the state. Prisoners suing the state asked for, among other things, a
measure, based on institutional design, shows
reduction in crowding and the hiring of more corrections officers (Crowder 2002).
that facilities were operating at 115 percent of
The corrections officers’ employee association sought to join in the lawsuit because
their capacity in 2004 (Harrison and Beck 2005).
officers felt imperiled by the extraordinarily low staffing levels, especially in such
(For more information about how crowding is
a crowded, unsafe environment (Johnson 2003).
measured, see p. 104.) Corrections administraUnder pressure by a federal judge, the state reduced the population at Tutwiler.
tors define the operational capacity of their own
But in a state prison system built for 12,000 that holds more than 26,000 prisoners,
facilities by drawing on a number of factors to
the only beds the state could find were in a private prison in Louisiana. The state
ensure that living conditions and services at least
has paid millions to send hundreds of women—generally those with the best
meet constitutional standards. In reality, correcrecords—500 miles from their children and families, where they now sit in a
tions administrators are often under pressure
cleaner, cooler, safer, but equally idle environment (Crowder 2005). By 2005, a
from county and state executives and legislators
year after the settlement of the lawsuit, the population remaining at Tutwiler had
to raise their operational capacity and somebeen reduced to roughly 700, and some of the unsafe conditions had improved.
times to exceed it. Moreover, many corrections
2 6     c o n d i t i o n s o f c o n f i n e m e n t

administrators believe that running at more than 90 percent of their system’s operational capacity deprives them of necessary flexibility. While
there is considerable variation among states and localities in levels of
crowding, the majority of prisons and many jails are crowded by that standard (Harrison and Beck 2005). “The average American prisoner lives in an
environment roughly the size of a king-size bed,” psychologist and prison
consultant Craig Haney told the Commission. He concluded that when
crowding is understood as much more than squeezing more beds into a
cell or unit, American prisons are “woefully overcrowded.”
How states and localities, legislators, law enforcement officials, and
judges should address the broad issue of system-wide crowding is beyond
the scope of this Commission’s work, but others, notably the Justice Kennedy Commission, have addressed this important issue (American Bar Association 2004). There is a dangerous mismatch between current capacity
and the demands of the criminal justice system. Legislators must choose
to either increase resources for corrections or reduce the demands placed
on our correctional systems. Without action, they will perpetuate a system
that too often leads to violence and abuse.

2

Promote productivity and rehabilitation. Invest in programs
that are proven to reduce violence and to change behavior over
the long term.
Few conditions compromise the safety and security of a correctional
institution more than idle prisoners. “Every parent, every educator, and,
yes, every corrections professional can attest to the veracity of our grandparents’ observations and admonishments that idle minds are the devil’s
workshop,” Devon Brown, corrections commissioner in New Jersey told
the Commission, lamenting the public’s ignorance about the links between
programming, safer prisons, and public safety.
Rehabilitation was the organizing principle of the American penal system
for much of the twentieth century. But beginning in the 1970s, politicians
began to rhetorically devalue rehabilitation. The result was that prisons
became, at least from the perspective of tough-on-crime policymakers and
much of the public, places that should protect society from criminality by
incapacitating and punishing instead of seeking to help and change (Garland
2001). While the prison population grew astronomically, funding for education, vocational training, and rehabilitative programming did not keep pace.
Sergeant Gary Harkins, a 25-year corrections veteran testified, “When
I first started at the Oregon State Pen, inmates had a wide range of educational and vocational programs. Inmates had the ability to earn a GED
and continue all the way up to obtaining a doctorate. Over the years we’ve
evolved to where we do not have any teachers on staff or even offer a
GED program for the inmates at the pen . . . .Today at the pen, out of 24
programs, only three remain.”
Nationwide, participation in prison educational and vocational programs declined dramatically between 1991 and 1997 despite increasing

Crowded facilities are
“inhumane, unsafe, idle,
and hopeless, precisely
the opposite of what
conscientious prison
administrators are
attempting to accomplish.”
Vincent Nathan,
law professor and prison consultant

prevent violence

27

“If you don’t have
programs, whether 	
they’re schools, jobs,
factories . . . that make up
the naturally occurring
forces that bring
compliance with your
rules, you are much more
likely to be relying on
force and handcuffs.”
Walter Dickey, former secretary of the
Wisconsin Department of Corrections

2 8     c o n d i t i o n s o f c o n f i n e m e n t

lengths of stay (Lynch and Sabol 2001). A 50-state study conducted in
2003 and 2004 found that the numbers of prisoners receiving some postsecondary education had increased since the mid-1990s, when programming was at the height of political disfavor, but that only five percent of
prisoners were enrolled in any form of post-secondary education. The bulk
of those prisoners—89 percent—were incarcerated in just 15 state prison
systems (Erisman and Bayer Contardo 2005).
The Commission heard from expert criminologists, psychologists, corrections professionals, and community advocates about the dangers associated with “warehousing” prisoners. Professor Walter Dickey, former secretary of the Wisconsin Department of Corrections, told the Commission,
“If you don’t have programs, whether they’re schools, jobs, factories . . . the
things again that make up the naturally occurring forces that bring compliance with your rules, you are much more likely to be relying on force and
handcuffs.” Increasingly, programs tested through research demonstrate
that the old pessimism of the 1970s about rehabilitation was misguided.
Targeted interventions work. In particular, highly structured programs that
help prisoners understand the motivations underlying their actions and
the consequences of their behavior can reduce misconduct in correctional
facilities and lower recidivism rates by at least 10 percent (Ward and Eccleston 2004). These “cognitive-behavioral” programs are becoming more
common. If implemented nationwide, they would reduce the number of
people re-incarcerated by tens of thousands. Education—particularly at
the college level—also reduces rule-breaking and disorder in prison. Studies show that post-secondary education can cut recidivism rates by nearly
half (Erisman and Bayer Contardo 2005).
In recent years, faith- and character-based programs have been promoted
to increase safety and reduce recidivism. These range from individual activities to entire faith-based facilities. According to a report by the National
Institute of Corrections, nearly half of state and federal prison systems are
operating or developing at least one residential, faith-based program (NIC
2005). These programs cultivate such things as life skills, anger management,
personal growth and faith, family relationships, and victim awareness.
Effective programming requires money, effort, and a recommitment to
rehabilitation. But it is not only an investment in safe prisons and jails. It
is also an investment in safe and healthy communities. Lawmakers have
a particular responsibility to fund programs that help prisoners returning
to communities with high rates of unemployment. Employment opportunities for young, African-American men are particularly grim, and their
persistent unemployment has a devastating effect on already poor communities. In some inner city areas, more than half of all African-American
males do not finish high school, and the unemployment rate for AfricanAmerican males who have dropped out is 72 percent. By their mid-thirties,
60 percent of all African-American men who have dropped out will spend
some time in prison. By comparison, the unemployment rates of white and
Latino males who drop out of high school are 34 percent and 19 percent

respectively (Eckholm 2006). We need a strong investment in education,
vocational training, and cognitive behavioral programs that have been
demonstrated to promote safety in the short and long term.

3

Use objective classification and direct supervision. Incorporate
violence prevention in every facility’s fundamental classification
and supervision procedures.
Reducing violence among prisoners depends on the decisions corrections
administrators make about where to house prisoners and how to supervise
them. Perhaps most important are the classification decisions managers
make to ensure that housing units do not contain incompatible individuals or groups of people: informants and those they informed about, repeat
violent offenders and vulnerable potential victims, and others who might
clash with violent consequences. And these classifications should not be
made on the basis of race or ethnicity, or their proxies (Johnson v. California
2005). Before 1980, most of the nation’s prisons and jails used “subjective
classification,” which relies heavily on the judgment and hunches of line
officers. Since then, every prison system has shifted, at least as a matter
of policy, to “objective classification.” These standardized and automated
classification criteria “place greater emphasis on fairness, consistency, and
openness in the decision-making process” (NIC 1992).
Numerous studies of both jails and prisons demonstrate that violent acts,
escapes, and deaths by violence can all be significantly reduced by using
a validated objective classification system (NIC 1992). But currently, the
full potential of this tool is not being realized. As James Austin, a leading
researcher, reported in 2003: “Although prison classification and other risk
assessment instruments are now common, there is a disturbing trend that
suggests that many of these systems were implemented without first being
properly designed and tested” (Austin 2003). In addition, many jails do not
use objective classification at all: In eight of the 21 states surveyed in 2003,
fewer than half of local jails reported using objective classification (Clem
and Sheanin 2003). Given the benefits, the Commission urges every facility with more than a few beds to develop, test, and implement an objective
classification system, drawing on others’ experience and relying on the
guidance of experts.
Prison and jail architecture, management, and models of supervision
combine to create either safe and humane conditions or disruptive and
dangerous ones. One extremely promising technique to promote safety
is “direct supervision.” In a facility that uses direct supervision, prisoners
generally spend at least half of their time out of their cells, mingling with
each other and with officers in “common areas.” The housing units in direct
supervision facilities are typically constructed as “pods,” with cells or tiers
of cells around the perimeter and a common area in the middle. Direct
supervision stands in stark contrast to the traditional model of supervision where corrections officers monitor prisoners’ living areas from posts
enclosed behind glass or bars.

What Americans Believe
When Americans think about someone they
know being incarcerated, the vast majority,

84 percent, say they would be

concerned about the person’s physical safety.

76 percent

And
say they would be
concerned about the person’s health.

55 percent,

More than half of Americans,
are acquainted with someone who has
been incarcerated or who has worked in a
correctional facility.

For the majority of Americans, knowing someone
who has spent time or worked in jail or prison

changed their impressions
of life behind bars.

source: survey in march and april of 2006 by
princeton survey research associates international
for the national center for state courts and the
commission on safety and abuse in america ’ s prisons

prevent violence

29

First developed by the Federal Bureau of Prisons in the early 1970s
and still underutilized, direct supervision “allows, and even requires,
continuous personal interaction between corrections officers and inmates by putting them together, face-to-face in the living unit” (NIC
1989). Security in any facility is heavily dependent upon the ability of
highly trained staff to detect and defuse potential problems. The difference between the two models of supervision is the difference between
interaction and reaction. Since officers in a direct supervision facility
are constantly engaging with prisoners, they are better able to recognize
signs of a potential problem before it manifests (NIC 1989).

Violent acts, escapes, and deaths by violence can all be significantly
reduced by using a validated objective classification system.
The impact on safety is impressive. The National Institute of Corrections
conducted the most comprehensive study to date of direct supervision. Its
1989 research showed that those who run direct supervision facilities gave
their own facilities higher safety ratings, compared with those who operate
facilities that use “indirect” supervision. The in-depth case studies concluded
that prisoners appear to feel considerably safer in direct supervision facilities and seem neither to have nor to need weapons to protect themselves.
The study’s authors noted that using direct supervision carries no greater
cost and requires no additional staff yet appears to produce a safer, more livable environment. Another study put some numbers on the improvements:
“Compared to traditional jails of similar size, the Metropolitan Correctional
Centers and other direct supervision jails report much less conflict among
inmates, and between inmates and staff. Violent incidents are reduced 30 to
90 percent” (Wener et al. 1987). Colonel David Parrish, Commander of the
jails in Hillsborough County, Florida, agrees: “Direct supervision is recognized by progressive jail administrators as the most practical way to build
and operate a detention facility. They are more staff efficient, cost-effective,
and safer than traditional jails,” he told the Commission.
Surprisingly, only a small minority of correctional facilities in the United
States use direct supervision. A 2001 NIC directory listed fewer than 300
jails with any direct supervision units; collectively, those units housed less
than a quarter of the nation’s total jail population (NIC 2001). A large part
of the resistance is attitudinal. “The first reaction to this arrangement by
traditional wardens, jail officials, and most visitors is usually astonishment.
They think of the public and staff safety in terms of hard barriers between
us and them. The new design seemingly places officers at the mercy of
inmates.” In reality, however, “Officers in constant and direct contact with
inmates get to know them and can recognize and respond to trouble before
it escalates into violence. They are no longer forced to wait to respond after
trouble starts. Negotiation and communication become more important
staff skills than brute strength” (Wener et al. 1987).
3 0     c o n d i t i o n s o f c o n f i n e m e n t

For direct supervision to be successful, of course, officers must have
the competence to understand and respect persons from different racial,
ethnic, and cultural backgrounds. And the opposite is also true: The more
natural environment of a direct supervision pod helps to break down
some of the differences between officers and staff that can contribute to
tension and violence.
Staff who rely on direct supervision prevent violence and model prosocial behavior. While the design of some facilities makes direct supervision
impossible, the Commission believes many more facilities could be converted and reap the benefits for prisoners and staff alike.

4

Use force, non-lethal weaponry, and restraints only as a last
resort.  Dramatically reduce the use of non-lethal weapons,
restraints, and physical force by using non-forceful responses
whenever possible, restricting the use of weaponry to qualified
staff, and eliminating the use of restraints except when necessary
to prevent serious injury to self or others.
Professional standards clearly prohibit corrections officers from using
more force than necessary and from using force to deter, punish, or retaliate, or to inflict pain and injury. But for many reasons, the standards are
not always successful in guiding behavior. There is real disagreement, and
no data nationally, about how often force is used, how often it escalates,
and how often it rises to the level of abuse. One thing is clear, however:
The more frequently force is used, the more chances there are for abuses
and injuries. Sergeant Michael Van Patten, a 20-year corrections veteran
who specializes in training officers, explained to the Commission that even
routine and minimal uses of force are “inherently violent.” And a number
of experts testified about the difficulty of controlling the amount of force
used once it comes into play. The goal at all times should be to address
conflicts that arise between staff and prisoners without resorting to force.
When force is necessary to prevent serious harm it should be limited in
degree and duration and carefully monitored.
Stories of corrections officers resorting to extreme and brutal violence
to assert their control stand out among news headlines. Not long ago in
Sacramento, California, a federal civil rights lawsuit was filed by a mortgage broker being held in the county jail for public intoxication. The key
piece of evidence in the suit, which alleges the sanctioned and ongoing
use of excessive force in the jail, is a surveillance tape of the prisoner, who
had refused to sit down in the drunk tank, lying in a pool of his own blood
after an officer allegedly pushed him to the floor, cracking open his skull
(Korber and Jewett 2005).
In the worst cases, people die. Former General Counsel of the Texas
prison system Steve Martin told the Commission that within the last
five to seven years, he has served as an expert in more than 20 in-custody
death cases in which prisoners died from being placed in a restraint chair, a
restraint board, or four- or five-point restraints. In most of those cases the
prevent violence

31

“Officers go from zero 	
to 150 in seconds.”
Officer Donald Joseph Baumann,
California Department of Corrections

32     c o n d i t i o n s o f c o n f i n e m e n t

prisoners were mentally ill, and most of them died of asphyxia. A federal
judge described numerous prisoners being stripped to their underwear and
strapped to a mattress at the wrists, ankles, and across the chest for roughly
48 hours with only brief interruptions of mobility. Speaking about one prisoner in particular, the judge recounted evidence that he was in immense
pain and hallucinating, and also urinated and vomited on himself: “Inmate
Sadler may deserve to be in prison, but he did not deserve to be strapped
to a bed for nearly two days” (Sadler v. Young 2004).
There are very few instances in which someone should be fully pinned
down in a restraint chair or in four- or five-point restraints. All correctional facilities should meet standards set by the American Correctional
Association that define the circumstances under which this kind of total
restraint is acceptable, require approval from a health authority, and call
for visual observation every 15 minutes (ACA Standards 4-4190 and 44191). And they should go further: The circumstances under which total
restraint is appropriate should be even narrower. Restraints should only
be used when absolutely necessary to prevent serious harm to self or
others. Equally important, complete physical restraint requires constant
monitoring, with a medical staff member present at all times, and should
be limited to minutes not hours.
Given the dangers inherent in any use of force, it should always be a
last resort. When he began his career as a corrections officer in California,
Lance Corcoran felt he “had to be the baddest guy in the valley [but]
recognized really quickly that that only made things more difficult as a
correctional officer.” Corcoran told the Commission that officers’ “most
important tool . . . is the ability to communicate.” However, Steve Martin
testified that pepper spray, TASER guns, and other non-lethal weapons are
often used as a “first strike” response before other tactics are considered or
attempted. He recounted a situation in which a prisoner had refused to
relinquish his dinner tray. The man was unarmed, locked securely in his cell,
and weighed only 130 pounds. Before even entering the cell, an “extraction
team” of five officers and a sergeant discharged two multiple baton rounds,
hitting the prisoner in the groin, dispensed two bursts of mace, and fired
two TASER cartridges. The team then entered the cell and forcefully removed the prisoner.
It does not take malice on the part of officers for force to escalate. Sergeant Michael Van Patten explained to the Commission that the fear and
adrenaline rush that naturally occurs in the moments prior to a cell extraction or planned use of force can cause officers to lose control and act more
violently than necessary. This same phenomenon was explained by Officer
Donald Joseph Baumann, a 19-year veteran of the California Department
of Corrections. “Officers go from zero to 150 in seconds,” he said. And
corrections officers feel they work under the constant threat of spontaneous violent outbursts; they literally feel under siege. That feeling can lead
officers, especially new and inexperienced ones, to overreact and use force
when talking would be more effective, or to use more force than necessary

to resolve a situation. And these altercations can start or perpetuate a cycle
of strikes and retaliation.
Other factors affect the decision to use force and how much force to
use. Patrick McManus, the former Secretary of the Kansas Department of
Corrections and an expert monitor in prison and jail systems nationwide,
cautioned that although officers are under stress, “I don’t know that that
is the crux of the problem with the use of force. . . . It’s an institutionalized
response that’s based on a way of thinking about how people relate to each
other in a prison.” Officers fail to recognize the individual characteristics

A federal judge described numerous prisoners being stripped to their
underwear and strapped to a mattress at the wrists, ankles, and across
the chest for roughly 48 hours with only brief interruptions of mobility.
of the person they are confronting and instead see merely an “inmate.”
Such perceptions can be exacerbated by cultural differences between officers and prisoners. Perceptions of danger, which spur forceful responses,
are especially susceptible to cultural misunderstandings and prejudices. As
sociologist and former prisoner Douglas Thompkins told the Commission, one must understand that race is often a “proxy for dangerousness.”
Efforts to understand and avert uses of force must include careful analysis
of the role of race, ethnicity, and class in these decisions and events. Careful screening of staff at the time of employment and ongoing, in-depth
training are necessary to ensure that an understanding of and respect for
cultural differences shapes how staff relate to prisoners.
Training and supervision must emphasize that force can only be considered after non-physical responses to conflict have been exhausted. Officers
need to learn how to distinguish between situations that require physical
force and those that do not. They also need to learn how to determine what
amount of force—if any—is required and when force is no longer necessary. Instruction should be backed up by a clear use-of-force hierarchy
that prescribes specific kinds and degrees of force in response to a limited
set of specific actions and situations, and it should outline de-escalation
techniques to prevent the use of force.
Conflicts between staff and prisoners arise even in the best-run institutions, but nearly all of those situations can be managed without using
physical force. While it might be instinctive to respond aggressively to
someone who is being aggressive, the safety of both staff and prisoners
depends on doing just the opposite. To talk merely of limiting the use of
force is to miss a much larger opportunity to reframe the role of corrections officers in resolving and preventing conflict. Officers need guidance,
inspiration, and a repertoire of effective, non-forceful responses so that the
use of force is naturally limited to those rare situations where it is required
to prevent serious harm.
prevent violence

33

5

“How could something so
devastating happen in a
supposedly secure and
monitored environment?. . .  
Why weren’t there any
cameras in the area where
my son was killed?”
Pearl Beale

3 4     c o n d i t i o n s o f c o n f i n e m e n t

Employ surveillance technology. Make good use of recording
surveillance cameras to monitor the correctional environment.
Pearl Beale’s son died after being stabbed nine times by another prisoner
while detained in a District of Columbia jail. After describing his death to
the Commission, Beale posed these questions: “How could something so
devastating happen in a supposedly secure and monitored environment?. . .
Why weren’t there any cameras in the area where my son was killed?”
In February, 2006, New York City settled a lawsuit filed on behalf
of prisoners who accused officers of unnecessarily using head strikes
and other acts of violence in the city’s jails. A principal component of
the settlement agreement is the installation of hundreds of new wallmounted video cameras with recording capability—in addition to the
2,000 cameras already in place—providing coverage of large areas of the
jails (Preston 2006, Ingles v. Toro 2006).
Whether violence occurs among prisoners or between staff and prisoners, surveillance cameras and other technologies can help. Their wider
use was urged by a range of Commission witnesses. U.S. Department of
Justice Inspector General Glenn Fine stressed the value of cameras for
prosecutors: “With video surveillance you often can see what happened
before or after an incident, so that’s very important, and we have relied
upon that kind of evidence very strongly.” These visual and auditory records protect prisoners and staff from violence and from false allegations
of misconduct. Leslie Walker, executive director of Massachusetts Correctional Legal Services, believes that cameras can even discourage the
“tiny, degrading, everyday humiliating name calling that can occur.” This
behavior, she said, will not be reported with any regularity or believed unless it is “seen and heard.”
There are other promising technologies. Non-invasive drug-detection
devices, such as booths and wands, might be used to minimize the confrontation and humiliation that accompany searches of prisoners after
visits or trips to court, searches that sometimes include the inspection of
body cavities. Women prisoners, who more often than men are survivors of
physical and sexual abuse, may be particularly traumatized by strip searches
and body-cavity searches and may even avoid family visits as a result. Technologies that offer some relief from physical intrusion should be developed
and deployed. Similarly, special computerized chairs that detect weapons
can replace hand searches, and radio frequency identification (RFID) tags
can track the movements of prisoners and staff, a powerful disincentive to
be in the wrong place at the wrong time.
Any technology has the potential for negative collateral consequences.
The additional stress and loss of dignity that might come from being monitored by surveillance cameras must be considered so that these approaches
to violence are not counter-productive—coverage typically excludes prisoners’ cells, for example. With due regard for these concerns, correctional
agencies should make use of recording surveillance cameras and other
technologies to prevent violence.

6

Support community and family bonds.  Reexamine where
prisons are located and where prisoners are assigned,
encourage visitation, and implement phone call reform.
Strong connections to family and community give hope to people in
prison—that elusive element that a correctional facility alone cannot provide but can, if it is not vigilant, destroy. And hope, it turns out, is critical
to avoiding violence. The storehouse of self-respect and pride that a person
finds in family and community can ward off the shame and humiliation
that lead one to violence while incarcerated (Gilligan 1996). For prisoners
who are parents, incarceration means being physically removed from children; for them it is critical that we make every effort to maintain family ties.
And as former prisoner A. Sage Smith explained, visits from community
volunteers “inject a sense of purpose into many prisoners’ consciousness”
and “bring a sense of concern and infuse a sense of hope” that can assist a
prisoner’s positive transformation. These relationships with people outside
the correctional facility also smooth the process of reentry and make it
more likely that prisoners will succeed after release.
The Commission was told about various ways to support community
and family bonds. We address three strategies here, although many others
should also be considered. First, unlike local jails, prisons are filled with
people who have been sent far from home, and in some cases transported
to other states. The physical distance to the facility can make it nearly impossible for family to visit regularly and impractical to connect prisoners
with groups based in their home communities. Recognizing the importance
of family and community bonds, many state systems move prisoners to facilities closer to their home communities in the final months before release.
But these bonds are important not only as part of the reentry process but as
an important ingredient for a safe environment during incarceration.
Decisions about where to send prisoners, combined with the siting of
many prisons far from the prisoners’ home communities, disproportionately
affect African-American and Latino families and exacerbate the racial divide between prisoners and officers. According to one study, those decisions
result in rural prisons, which have a greater concentration of white staff,
holding higher percentages of African-American men than correctional
facilities in urban areas (Farrigan and Glasmeier 2002). There is widespread
agreement that for incarceration to be productive, support must be given to
preserving a prisoner’s bonds with his or her family and community.
There are many reasons states build prisons in rural locations far from
the urban centers from which most prisoners come: lower-cost land, a
more favorable political environment, and the perception of a larger employment pool. These factors—reasonable in theory, sometimes debatable
in practice—must be considered against the weakening of prisoners’ ties
with family and community. While a shift in priorities would require
tremendous political will, lawmakers should at least examine the impact
of decisions about where to locate prisons. In the meantime, corrections
administrators should look closely at their internal process for assigning
prevent violence

35

The Cost of Keeping in Touch
When people are incarcerated far from home, phone
calls with partners, children, and parents are often
the only practical way for these families to stay in
touch. Calling rates vary considerably from state
to state. Where collect calling is the only option
and the rates are high, poor families make large
sacrifices to speak with an incarcerated loved one.

Average cost of a 15-minute in-state long-distance
collect call placed from a correctional facility
nebraska $2.25
new mexico

$4.38

vermont

$4.70

nevada

$5.03

florida

$5.32

new jersey

$9.00

washington

$17.77

State correctional facilities that enter into
exclusive contracts with telephone companies

30 to 40 percent

typically reap
of all revenue generated—enormous sums that
state legislatures have come to depend on.
Florida’s Inmate Welfare Trust Fund
took in

$15.3 million in fiscal year 2000.

Nevada collected

$20.5 million in 1999.
sources: calling rates provided by citizens united
for the rehabilitation of errants (cure);
information about commissions provided by
the american bar association and by alan elsner in
his book gates of injustice.

3 6     c o n d i t i o n s o f c o n f i n e m e n t

people to facilities and make decisions whenever possible that preserve
family bonds. And no system should send their prisoners to other states.
Second, both prisons and jails must do a better job of welcoming visitors,
providing ample space and time, and even assisting with transportation.
There are costs involved to do this well, but these dollars would be well
spent. And in many places the most needed investment is in a change of
attitude. Visitors are often sent the erroneous and harmful message that
they are not welcome in a facility and that they do not play an important
role in supporting prisoners and the well-being of the facility. There are
valid security concerns that require restrictions on visitation. Nonetheless,
author asha bandele described to the Commission the humiliating and
capricious treatment she received when visiting her incarcerated husband.
She explained the consequences: “[Poor] treatment of family members has
the potential to make the facility less secure because it can lead to severe
tensions between a prisoner and a guard who humiliated or otherwise
violated his wife.”
Another way to encourage visitation is by allowing the greatest degree possible of closeness and privacy, given security imperatives. Because
contact visits can inspire good behavior, people confined in both prisons
and jails should be allowed to touch and embrace their children, partners,
and other friends and family. Physical barriers and telephones should be
reserved for those who have abused visitation privileges or otherwise have
been determined to pose too great a risk. The Commission was told that
people detained in the Washington, D.C., jails prefer to be held in the
privately run facility rather than the public jail because, despite some of its
disadvantages, it allows contact visits with family.
The final way correctional systems, principally prisons, might support family and community bonds is by minimizing the cost of prisoners’ telephone
calls. At present, most state systems allow only collect calls from prisoners
(typically no direct calls out or incoming calls are allowed) and do so through
contracts with providers that charge the recipient extraordinarily high rates,
with the state receiving a commission. For example, in Florida, where only
collect calls are allowed, a prisoner’s 15-minute in-state long-distance call
from prison costs $5.32. Calling someone out of state costs $17.30.
The state earned over $15 million in commissions on prisoners’ calls in
2000 (Citizens United for the Rehabilitation of Errants, Florida Corrections Commission).
A growing group of corrections leaders recognizes the critical importance of telephone communication for prisoners and their families. The
American Correctional Association has taken the position that prisoners
“should have access to a range of reasonably priced telecommunications
services” with rates “commensurate with those charged to the general
public” (ACA 2001). But many directors of state departments of corrections have been pressured by shortsighted legislatures to use telephone
contracts to seek income for state general funds or corrections budgets
rather than to ensure family unification. The result is that family members

of prisoners pay many times more than anyone else for the opportunity to
speak with a loved one.
There has been considerable effort to convince lawmakers that, regardless
of the income from telephone charges, interference with family unification
is too high a price to pay. The American Bar Association recently adopted a
recommendation urging “the lowest possible rates,” among other measures
to ensure ready telephone contact (ABA 2005). Some states are responding.
Vermont requires phone contracts to offer prisoners the option of direct or
collect calling at “the lowest reasonable cost” (Vt. Stat. Ann. tit. 28 §802a).
New Mexico’s statute bars its prisons and jails from receiving commissions
on the amount billed and requires “the lowest cost of service” (N.M. Stat.
Ann. §33-14-1). The District of Columbia bars correctional facilities from
charging higher than local Public Service Commission rates and also bars
surcharges on prisoner calls (D.C. Code Ann. §24-263.01).
Meanwhile, practices in some states more drastically interfere with
prisoners’ ability to maintain family and community bonds through phone
contact. In Texas, for example, the very ability to make calls is severely
restricted: “Offenders who demonstrate good behavior can earn one fiveminute call every 90 days” (Texas Department of Criminal Justice 2006).
State legislatures and correctional systems must end practices such as
these that interfere with the maintenance of critically important family
and community ties.

Strong connections to
family and community
give hope to people 	
in prison. And hope, 	
it turns out, is critical to
avoiding violence.

prevent violence: recommendations recap
1.	 Reduce crowding. States and localities must commit to eliminating the crowded
conditions that exist in many of the country’s prisons and jails and work with
corrections administrators to set and meet reasonable limits on the number of
prisoners that facilities can safely house.
2.	 Promote productivity and rehabilitation. Invest in programs that are proven
to reduce violence and to change behavior over the long term.
3.	 Use objective classification and direct supervision. Incorporate violence
prevention in every facility’s fundamental classification and supervision
procedures.
4.	 Use force, non-lethal weaponry, and restraints only as a last resort. Dramatically
reduce the use of non-lethal weapons, restraints, and physical force by using
non-forceful responses whenever possible, restricting the use of weaponry to
qualified staff, and eliminating the use of restraints except when necessary to
prevent serious injury to self or others.
5.	 Employ surveillance technology. Make good use of recording surveillance
cameras to monitor the correctional environment.
6.	 Support community and family bonds. Reexamine where prisons are located
and where prisoners are assigned, encourage visitation, and implement phone
call reform.

prevent violence

37

Provide Health Care
that Protects Everyone

recommendations
1.	 Partner with health providers from the
community.
2.	 Build real partnerships within
facilities.
3.	 Commit to caring for persons with
mental illness.
4.	 Screen, test, and treat for infectious
disease.
5.	 End co-payments for medical care.
6.	 Extend Medicaid and Medicare to
eligible prisoners.

38

conditions of confinement

much of the public imagines jails and prisons as sealed
institutions, where what happens inside remains inside. In the context of
disease and illness, which can travel naturally from one environment to
another, that view is clearly wrong. Protecting the public health, reducing human suffering, fulfilling our constitutional obligation to those we
incarcerate, and addressing the financial cost of untreated illness depends
on good and adequately funded correctional health care.
Every year, more than 1.5 million people are released from jail and prison
carrying a life-threatening infectious disease (NCCHC 2002). At least 300,000
to 400,000 prisoners have a serious mental illness—a number three times the
population of state mental hospitals nationwide (Ditton 1999, Human Rights
Watch 2003). And prisoners on average require significantly more health care
than most Americans because of poverty, substance abuse, and because they
most often come from underserved communities (Marquart et al. 1997).
Until the late 1970s, substandard health care prevailed in correctional facilities. There have been dramatic improvements since then, but the gains have
not been equal everywhere. “Some health-care programs are really excellent,”
leading correctional medicine and public-health expert Dr. Robert Greifinger
told the Commission. “And others in this country . . . too many of them are
shameful, not only in terms of what we do to the individuals but shameful in
terms of the risks we expose our staff to and the risks to the public health.”
Many corrections leaders are struggling to provide quality care without
adequate resources and often without frontline staff who understand and
share their goal. The consequences for individuals and families can be
tragic. In California, where control of health care in state prisons has been
ceded to a federal judge, one prisoner was dying needlessly from medical malpractice or neglect every six to seven days as recently as October
2005. “This statistic, awful as it is,” wrote federal Judge Thelton Henderson,
“barely provides a window into the waste of human life occurring behind
California’s prison walls” (Plata v. Schwarzenegger 2005). Dr. Joe Goldenson, who has investigated the problems in California, reminded the Commission that even though violence is the “usual suspect,” poor health care
causes more injuries and deaths inside jails and prisons across the country.
Correctional facilities have a constitutional obligation to provide
health care—and some fulfill that obligation with vigor. They also have a

tremendous opportunity: to protect the public health and to use precious
health-care resources efficiently through disease prevention, early detection, and appropriate treatment. But corrections cannot do this alone, and
legislatures chronically underfund correctional health care. Medical experts
and prison and jail administrators who testified before the Commission
delivered that message clearly. With their words in mind, the Commission urges lawmakers to adequately fund correctional health care. We also
urge the development of real partnerships between corrections and community health-care providers and between individual caregivers and staff
responsible for maintaining security within facilities. This chapter explores
the benefits of such partnerships and recommends other ways to improve
health care in prisons and jails—because everyone’s health depends on it.

1

Partner with health providers from the community. Departments
of corrections and health providers from the community should
join together in the common project of delivering high-quality health
care that protects prisoners and the public.
Jails and prisons are expected to provide medical and mental health
care for millions of people every year, most of whom are poor and many of
whom have serious health needs that were not appropriately treated before
incarceration. In particular, there are significant disparities between the
access to and quality of health care that African-Americans and Latinos
receive compared with white Americans—disparities that must either be
addressed or they will be exacerbated in our prisons and jails. In nearly
every state and in most local jurisdictions, correctional systems attempt
this mammoth task with less than adequate funding and, more surprising,
with little or no help from state and local public health agencies and other
community health-care providers (NCCHC 2002).
According to a 2003 survey by the National Institute of Corrections, collaborations between correctional and public health agencies are largely limited to screening, testing, and educating prisoners about an important but
narrow group of infectious diseases, particularly HIV and tuberculosis (NIC
2003). Arthur Wallenstein, who oversees corrections in Montgomery County,
Maryland, lamented to the Commission that most public health agencies do
not even urge the department of corrections in their state or county to seek
accreditation by the National Commission on Correctional Health Care.
It is disappointing that public health departments have not taken a more
active role in ensuring quality health care for prisoners and that county
and state executives have not encouraged partnerships between jails and
prisons and a broad range of community health-care providers—including public hospitals, local clinics, teaching institutions, and doctors and
nurses in private practice. While such partnerships are unusual, there are
successful ventures in certain counties and states around the country that
should inspire others. Some of the strongest partnerships can be found in
Hampden County, Massachusetts; King County, Washington; Montgomery County, Maryland; and San Francisco, California, and strong statewide

“Some health care
programs are really
excellent. And others in
this country . . . too many
of them are shameful,
not only in terms of
what we do to the
individuals but shameful
in terms of the risks
we expose our staff to
and the risks to the
public health.”
Dr. Robert Greifinger, correctional
medicine and public-health expert

p r ov i d e h e a lt h c a r e t h at p r ot e c t s e v e ryo n e

39

partnerships have been identified in Connecticut, Massachusetts, Ohio,
South Dakota, and Texas (NIC 2003, Raimer and Stobo 2004, Hampden
County Sheriff ’s Department 2002).
Joined together, these correctional agencies and health-care providers
from the community are overcoming one of the most significant barriers
to good correctional health care: recruiting qualified and caring medical
and mental health staff. Jails and prisons must hire doctors, nurses, physicians assistants, clinical social workers, and other health-care providers
despite low pay and difficult working conditions, lack of prestige, and in
many cases, a remote or impoverished location. And they must contract for
expensive and scarce specialty services despite the same obstacles.
Corrections administrators and experts agree that when state and local
correctional systems fail to deliver adequate medical care, understaffing and
a reliance on underqualified staff are often to blame. Researchers Michael
Vaughn and Leo Carroll write that “Prison medical care sometimes is delivered by unlicensed physicians, doctors with substance abuse problems,
doctors with criminal histories, and licensed and
Committed, Culturally Competent Caregivers
qualified doctors who treat ailments for which
Providing health care to a stigmatized population in a challenging environment
they lack training or experience” (Vaughn and
and often with severely limited resources requires personal and professional
Carroll 1998). In his testimony to the Commiscommitment and a high degree of cultural competence. Correctional facilities
sion, Dr. Joe Goldenson was explicit about the
should seek to hire culturally competent medical and mental health-care providers
staffing crisis in California’s prisons: “There are
and to enhance this set of skills through ongoing training for all staff.
facilities with four or five thousand people that
Treatment providers must be able to understand and empathize and
only have two or three doctors,” he said.
communicate with their patients. A disproportionate number of the people in
Providing specialty care is a particular problem.
this country’s prisons and jails are African-American and Latino and come from
For example, prisoners with HIV and hepatitis
mostly urban communities. In some states, they are sent to prisons in rural areas
C need expert care that can be difficult to prowhere most people are white and have had very limited interaction with urban
vide on site. That often means long waits to see
people of color. These medical and mental health care staff may lack even the
specialists. And because specialists are unlikely
most basic understanding of the populations they are serving and may not be able
to be in regular communication with the corto communicate successfully across cultural and language differences. They may
rectional facility’s primary caregivers, questions
also lack experience recognizing and treating illnesses that are common in the
about treatment may not be readily answered,
incarcerated population but uncommon in their home communities. The growing
adverse effects and other complications may
number of women in prison suggests a need to hire and train staff who can meet
not be promptly addressed, and there is a good
their specific health-care needs.
chance that the recommended treatment regiThe work of identifying and diagnosing mental illness, for example, hinges on
men will be interrupted or not followed at all.
cultural competency. Staff must be able to disentangle healthy but different cultural
Partnerships with community and public
behaviors from signs of illness. Understanding the perceptions about mental
health providers broaden the pool of qualified
illness in the communities from which prisoners come is key to accurate diagnosis.
caregivers who are committed to working in a
And since prisoners are vulnerable to being disciplined for misbehavior that stems
correctional environment by allowing them to
from a mental illness, basic cultural competency is important for security staff as
remain connected with community clinics and
well as for health-care workers. According to former prisoner A. Sage Smith, too
hospitals, teaching universities, and public health
often white officers fail to recognize mental illness in African-American prisoners
agencies. The partnerships increase the chances
and see only the resulting misbehavior. Where cultural competence does not occur
that caregivers will have some sensitivity to the
naturally, it should be cultivated through targeted recruitment and incentives,
particular cultural and language barriers that
careful training, and guidance on the job.
can diminish care to poor people of color in any
40

conditions of confinement

setting. Partnerships also guarantee that contagious and costly diseases
are managed by a network of knowledgeable health-care providers who
also bear responsibility for public health. Those providers literally bring
their community practice into the prison or jail, cultivating a standard
of care—and a caring attitude—inside correctional facilities equal to the
community standard of care. And the participation of “outsiders” helps to
transform jails and prisons from closed and stigmatized environments to
open and respected ones.
Finally, a partnership between health-care providers from the community and the local jail dramatically increases the odds that people will have
clear access to necessary health services after release—sometimes from the
very same doctors and nurses who treated them in jail. Continuity of care is
critical for their health, for their chances of success after release, and for the
health and safety of the public. As Arthur Wallenstein wrote to the Commission, “We have no desire to build a model jail program. What we’re
building is a solid community mental health system where corrections and
the jail is a component of the system, not the focal point.” Partnerships
involving prisons can have the same benefit, if those correctional facilities
are located close to the communities people return to after release.
Partnerships between correctional agencies and community health-care
providers are not a silver bullet. They cannot compensate for gross lack
Arthur Wallenstein, director,
Department of Correction and Rehabilitation,
of funding for correctional health care. In some communities health-care
Montgomery
County, Maryland
providers are too strapped or otherwise unable to handle the responsibility of delivering correctional health care. In rural areas, partnerships may
not create a culturally competent health-care staff that is experienced
in the medical and mental health problems common among prisoners (see “Committed, Culturally Competent Caregivers,” opposite page).
And partnerships are not easy to develop and
maintain. They require openness and flexibility
Not Fully Qualified to Practice Medicine
on the part of participating correctional agenWould you want a primary care physician who practices under a license that barred
cies, a broad-minded sense of mission, and a
him or her from treating most people? Remarkably, some states allow doctors
deep commitment to that mission on the part of
who have scars on their professional records to practice under a special license
participating public health agencies. But given
that restricts their work to prisons and jails. All too often correctional health care
the health-care needs of prisoners and the risks
is being provided by doctors, nurses, and others who could not find employment
of failing to meet those needs, the Commiselsewhere due to restrictions on their licenses or for other reasons.
sion urges correctional agencies and community
Since 1999, the National Commission on Correctional Health Care (NCCHC) has
health-care providers to consider the benefits of
taken the position that correctional agencies should employ only fully-licensed
forging solid partnerships.
health-care professionals and that state medical boards should not grant licenses

“We have no desire to build
a model jail program.

What we’re building is a

solid community mental
health system where

corrections and the jail is

a component of the system,
not the focal point.”

2

Build real partnerships within facilities.
Corrections administrators and officers
must develop collaborative working
relationships with those who provide health
care to prisoners.
Inside a prison or jail, even a minimum security facility, the environment is tightly controlled.

that restrict employment to a correctional environment. “[S]uch practice imparts a
sense that patients in a correctional environment are undeserving of qualified care

that is similar to care available in the community. This concept is anathema to the
important medical canons of ethics and disregards the important public health role
correctional health care can play.” The NCCHC also acknowledges that physicians
with restricted licenses, who are less likely to find employment elsewhere, may be
more susceptible to pressures to modify or avoid necessary patient care in order to
conform to conflicting security procedures or to save money (NCCHC 2005).
p r ov i d e h e a lt h c a r e t h at p r ot e c t s e v e ryo n e

41

Corrections workers are accustomed to dictating when and where prisoners can go within the facility, what items they can possess, and who they
can talk to and interact with. Health-care professionals are also accustomed to functioning in environments where they “call the shots.” Unless
the two groups of professionals understand, respect, and support each
others’ roles and obligations, there will be constant conflict between them,
with sick prisoners caught in the middle.
Dr. Robert Cohen, former director of medical services for the New
York City Department of Correction and a national expert on correctional health care, explained to the Commission
Working Together in Hampden County, Mass.
how such conflicts can develop: “When you send
Through partnerships with local, nonprofit health care centers, the Hampden
someone out of the facility, it means you are disCounty Correctional Center is protecting the health of prisoners and the health of
rupting the facility. When you are ordering pain
the surrounding community. The correctional center in Ludlow, Massachusetts,
medication, you are potentially allowing pain
draws on local medical clinics and hospitals, the state Department of Public Health,
medication to be in the institution. When you
and individual practitioners to provide medical, mental health, dental, and vision
are declaring an emergency, you are moving peocare both inside the institution and in the community after people are released.
ple around who perhaps should not be routinely
Doctors and other treatment providers from neighborhood clinics spend part
moved around. So there is fundamental conflict.”
of their work week providing care inside the correctional center—a complex of
Given that health care staff in most facilities are,
facilities housing about 1,800 male and female pre-trial and sentenced prisoners.
in the words of Dr. Joe Goldenson, “three or four
Ninety percent of those prisoners will return to local urban neighborhoods. With
rungs down on the supervisory chain,” decisions
their dual practice, the treatment providers bring the community standard of care
about whether someone can have a crutch, see a
into the correctional facility and their familiarity with and commitment to serving
psychiatrist, or be transferred to another facility
the local Latino and African-American communities. Each prisoner is matched with
for specialty care are effectively being made by
a treatment provider based on the prisoner’s home zip code so that the person can
corrections staff with no medical training. The
continue to see the same treatment provider after release.
same is true for crucial decisions about healthCollaboration between health-care and corrections professionals exists at all
care staffing and budgets.
levels, which ensures that everyone understands the central role of providing
What is needed to minimize conflict between
quality health care. The health-care director is among the senior administrators
the professions—and the potentially awful conwho run the correctional center. And corrections officers collaborate as true
sequences of delaying or withholding necessary
partners with medical staff. Thorough and continual cross-training makes those
care—is a true partnership. And that starts at
partnerships possible. Together the staff learn how to identify illness and provide
the top. Senior medical staff must be partners
health care in a culturally diverse and multilingual correctional setting.
with the senior correctional staff in designing
These partnerships enable the correctional facility to provide high-quality care
a health-care delivery system that works and is
at a cost lower than the average of the nation’s 30 largest jails (Hampden County
highly valued, and collaboration between healthSheriff’s Department 2002). Equally important, the partnerships have strengthened
care and security staff must continue down the
health care in the community by linking treatment providers with the population
chain of command.
most in need—not only prisoners but also their families—saving the county and
The underlying idea is interdependence:
state significant costs down the road. It is an approach rooted in the principles of
Medical staff should be solely responsible for
good public health: early detection, prompt and effective treatment, comprehensive
making health-care decisions, but they cannot
education and prevention services, and ongoing care. It reflects Sheriff Michael
function effectively, especially given their small
Ashe’s vision of the correctional center as part of the community. That vision also
numbers, without cooperation and assistance
influences the correctional center’s programming and reentry planning, services
from security staff. For example, all prisoners
that have resulted in a re-incarceration rate far lower than the national average.
should have some way of confidentially reportThe Robert Wood Johnson Foundation is committing $7.5 million to replicate the
ing a health problem directly to a health-care
Hampden County model at up to 16 correctional facilities across the nation.
provider. This is not only an important right, it
42

conditions of confinement

also encourages prisoners to seek treatment early, when it can be most effective and least costly. At the same time, security personnel—who spend
much more time with prisoners than health-care providers do—should
be encouraged and trained to be attuned and sympathetic to the needs
of prisoners and to alert health-care providers early on about signs of a
developing health problem.
This vision of the role of the corrections officer differs greatly from the
reality in many facilities today. But it is a role that corrections officers could
be trained to fill, assuming they have the interest and motivation to do
it well. Correctional systems could even develop a new role: health-care/
security officer. Such a staff person would act as an ombudsman rather than
a gatekeeper: a welcoming ear and confidential advocate for someone with
a medical or mental health problem. If well-designed and carefully staffed,
such a position would go a long way toward realizing the Commission’s
recommendation to develop collaborative working relationships between
health-care and security staff and thereby improve the health and wellbeing of the prison community.

3

Commit to caring for persons with mental illness. Legislators and
executive branch officials, including corrections administrators,
need to commit adequate resources to identify and treat mentally ill
prisoners and, simultaneously, to reduce the number of people with
mental illness in prisons and jails.
The need for mental health care in our country’s prisons and jails
is enormous. The most conservative estimate of prevalence—16 percent—means that there are at least 350,000 mentally ill people in jail
and prison on any given day (Ditton 1999). Other estimates of prevalence have yielded much higher rates, even of “serious” mental disorders—as high as 36.5 percent or 54 percent when anxiety disorders
are included (NCCHC 2002, Pinta 1999, Teplin et al. 1997). These
prevalence rates are two to four times higher than rates among the
general public (NCCHC 2002). They reflect what many witnesses told
the Commission: that prisons and jails have replaced state psychiatric
hospitals as the institutions that house and care for persons with mental
illness. Reginald Wilkinson, who made care of mentally ill prisoners a
priority of his 15-year tenure leading the Ohio Department of Rehabilitation and Correction, put it simply: “Detention facilities have, in fact,
become the new asylums.” The result is not only needless suffering by
the individuals who are undertreated but safety problems those prisoners cause staff and other prisoners.
By all accounts, corrections administrators are struggling to meet these
needs, often with grossly insufficient resources. Reflecting on this “tragic reality,” Louisiana Secretary of Public Safety and Corrections Richard Stalder
warned: “Without the resources, without the staff, without the professionalism that’s needed to cope with those kinds of problems, you will not have
the kind of safe environment that you promote as a Commission.”

Decisions about whether
someone can have a
crutch, see a psychiatrist,
or be transferred to
another facility for
specialty care are
effectively being made
by corrections staff with
no medical training.

p r ov i d e h e a lt h c a r e t h at p r ot e c t s e v e ryo n e

43

Those resources range from psychiatric hospital beds to intermediate care housing separate from the general prisoner population, from
therapy and medication to targeted programming. In each of these areas
the Commissioners heard about long waiting lists for few available slots
and the consequences of delaying or withholding care: suffering, selfmutilation, rage and violence, unnecessary placement in segregation,
victimization, and suicide.
Most state systems run or have access to secure psychiatric hospital
beds, but those beds cannot accommodate all the prisoners who need
the intensive treatment and protection of a hospital setting. New York,
for example, relies on the Central New York
Careful Screening for Mental Illness
Psychiatric Center, run by the state Office of
in Montgomery County, Md.
Mental Health. It offers excellent care, but since
Screening for mental illness is a regular part of the admissions process in most
it has only 210 beds, lengths of stay are often
prisons and jails. The American Correctional Association has standards that require
shorter than necessary and the return rate is
a brief mental health assessment at intake, as well as more extensive mental health
high (65 percent). Often, people who become
appraisals and evaluations where indicated (ACA 2003, Standards 4-4370 through
stable in the hospital have to give up their beds
4-4372). The quality of that initial screening, however, is uneven around the country
for others in crisis and then end up back in the
and, far too often, limited to gathering a history of prior treatment. That means a
hospital when their mental state deteriorates
significant number of mentally ill individuals are entering facilities undetected.
again (New York State Office of Mental Health,
Careful screening at intake is vitally important for the safety of everyone in the
Correctional Association of New York 2004).
facility: Half of all suicides in jails occur in the first 24 hours. Proper classification
Nationwide in 2000, correctional facilities reby risk requires knowledge of a new prisoner’s mental health (Kupers 1999). Also,
ported that just 1.6 percent of prison inmates
in jails where stays are often short, good mental health screening is the first step
were receiving 24-hour mental health care
toward lining up treatment in the community after release and can even facilitate
(Beck and Maruschak 2001). More acute care
early release.
beds are needed to serve the estimated six to 20
Administrators and staff of the jail in Montgomery County, Maryland, are
percent of prisoners who have a severe mental
committed to all of these goals. In an attempt to identify everyone who has a mental
illness (Scott and Gerbasi 2005).
illness and divert as many as possible to community treatment, two corrections
Intermediate-level care is also lacking. “There
officers and a registered nurse separately ask incoming prisoners a dozen standard
need to be more step-down units, roughly equivaquestions concerning their mental health. A single “yes” triggers a referral to
lent to residential treatment facilities in the comClinical Assessment and Triage Services (CATS)—three to 25 referrals a day, out of
munity, where prisoners with serious mental disan average of 40 admissions, according to Athena Morrow who supervises CATS.
orders can be partially sheltered as they undergo
And as a result of the unit’s community outreach efforts and close collaboration
treatment,” psychiatrist Terry Kupers, author of
between the public health and justice systems, mothers, lawyers, police officers,
Prison Madness, wrote to the Commission. Here
and community health workers often call the unit when a mentally ill person they
too, New York has an admirable model, with Inknow has been arrested.
termediate Care Programs (ICPs) located in 11
One goal for Morrow and her intake screening staff—all mental health
of the state’s 70 prisons. According to the Corprofessionals with masters degrees—is to arrange for treatment in the community
rectional Association of New York, a legislativelyand to recommend release at that day’s bail hearing whenever appropriate.
authorized prison oversight group, the ICPs
Although physically located in the jail, the staff are employees of the County
“perform an essential function for inmates with
Department of Health and Human Services, which makes it easier for them to
serious mental illness. They offer a therapeutic,
ensure continuity of care after release. Individuals who are not diverted are referred
safe environment and access to a range of services”
to the Department of Correction’s Mental Health Services Unit for evaluation. Those
(Correctional Association of New York 2004). But
who cannot be housed in the general population are admitted to the jail’s Crisis
there are places for just 534 people in the ICPs,
Intervention Unit, the county’s largest inpatient psychiatric care center.
far too few, given that there are at least 10,000
44

conditions of confinement

mentally ill prisoners in New York, based on a conservative estimate of the
prevalence of mental illness among prisoners nationally.
While there is a need for more specialized housing for mentally ill
prisoners, those separate environments also have a disadvantage: Hospitalized prisoners and those in intermediate care centers have much less or
no access to work and vocational training, education, and other types of
programming that support good mental health. Leonard Branch, psychologist for the corrections department in Orange County, Florida, told the
Commission, “We try to balance the desire to mainstream inmates with
concerns about their health and safety.”
Faced with a large number of mentally ill individuals and a lack of
treatment services, facilities can be tempted to rely mainly or exclusively on medication, both to relieve suffering and to control people. As
Professor Kenneth Adams told the Commission, “There are some wonderful pharmaceuticals out there that do amazing things in terms of
helping people along, but that’s not the sum total of treatment in terms
of what these people need. They need more than that.” Similarly, the
American Psychiatric Association warns of a troubling tendency to focus
the precious few resources on treating those who suffer from what are
termed major or severe mental illnesses—psychoses, major depression,

There are at least
350,000 mentally ill
people in jail and
prison on any given day.

Mental Illness: The Gender Gap
Women prisoners are far more likely than men to identify as having a mental illness and, among
those who do identify as mentally ill, women are far more likely than men to report a history of sexual
and physical abuse. The American Psychiatric Association recommends developing treatment programs
especially for women prisoners that can address their history of trauma.
Identify as mentally ill

Mentally ill who report
a history of sexual abuse

state prisons
women

Mentally ill who report
a history of physical abuse

men
women

men

women

men

16%

24%

59

15

68

27

jails
women

men
women

23%

men

women

men

16%
63

17

60

25

source: bureau of justice statistics

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45

and bipolar disorder—with insufficient attention paid to other disorders
that are more likely to result in silent suffering rather than disruptive
behavior (American Psychiatric Association 2000, Council of State
Governments 2002).
The lack of mental health resources manifests in yet another way: as
a dearth of skilled, caring professionals. The Commission heard from
a number of witnesses about inadequate staffing levels, high turnover,
and staff who are underqualified, under-motivated, or just “burned out.”
Former prisoner Thomas Farrow, who suffers from bipolar disorder, told
the Commission that he was lucky to see any single psychiatrist or psychologist more than three times over his decade of incarceration and
that most of these encounters were extremely brief, lasting for about 15
minutes. He also talked about the difficulty of trusting doctors in prison.
“We all heard the story about the prisoner who was strapped naked into
a restraining chair and forced to take his medication, and while this may
not happen that often, it is a fear we all share
Some Mother’s Son
and this fear motivated many prisoners to avoid
My son is 20 years old and has been incarcerated most of his legal adult life so far
any contact with mental health providers.”
due to having a drug problem, thefts, and mental illness. David has been in the
The Commission also heard, time and again,
DOC for several months now, and has only written one letter in which he simply
that the first step in improving the ability of
stated that he was in a psych ward, and that he loved us with all his heart and
correctional systems to address the enormous
soul. I have written many times, and I get no response. I attempted to visit David
mental health issues of prisoners is to improve
a couple of months ago, and I was told that David refused to visit. I have heard
and expand community mental health treatthrough an inside contact as to a disturbing situation that occurred that I am not
ment and thus to have options other than insure was not my son.
carceration, especially for mentally ill people
The incident involved a man in the same unit that my son was in who was
who commit lower-level offenses. Jails in parscreaming, playing in his feces, and obviously having serious mental health
ticular are burdened by huge numbers of people
issues. Because this man was screaming, the “goons”—apparently men dressed
with mental illnesses. In jails more than prisons,
in black—came into the cell and beat this man and hosed down the cell. Soon after
treatment options are limited by the very short
the incident, this man was reportedly taken away to another area. This incident
stays of most people who are admitted, making
reportedly occurred in housing unit Nine. My son was in housing unit Nine for a
screening and discharge planning the best way
brief period, before being transferred to housing unit Five, “the hole.”
to ensure treatment in the community.
When I call the DOC and ask to speak with a “case manager,” I never seem to get
“We should aspire to a zero tolerance policy
the same person twice. The psychiatrists cannot tell me much of anything because
for psychological misery and pain that could be
of HIPAA [a federal statute protecting doctor-patient confidentiality], which I
alleviated by appropriate mental health treatunderstand as an R.N. However I do not think that David is mentally competent
ment,” Jamie Fellner testified to the Commis(with the limited information and insight that I have) to make that decision.
sion, “but that standard cannot be met without
I also feel that it is too easy for mentally impaired inmates to be abused and
better funding.” Fellner is director of U.S. proessentially “hidden” from family members and loved ones by putting the inmate
grams for Human Rights Watch and an author
in “the hole” and simply stating that the inmate is “refusing” release of personal
of Ill Equipped: U.S. Prisons and Offenders with
information, visits, and even mail. I am not stating that this has definitely happened
Mental Illness. Lawmakers and corrections adto anyone, for I do not know for certain that it has . . . . But I feel that there is certain
ministrators surely need to commit more repotential for inmates to be abused, and for that abuse to be hidden from loved
sources toward identifying and treating the
ones. It is scary and disgusting to me to think that there is even a chance that this
mentally ill in prison and jail, but that is only
occurs—whether it occurs to my son, or any other inmate.
part of the solution. Our jails and prisons should
—Excerpts from a letter sent to the Commission on December 14, 2005
not have to function as mental institutions.
46

conditions of confinement

As a society, we need to expand and improve community-based treatment
for persons with mental illness.

4

Screen, test, and treat for infectious disease. Every U.S. prison
and jail should screen, test, and treat for infectious diseases
under the oversight of public health authorities and in compliance
with national guidelines and ensure continuity of care upon release.
Dr. Robert Greifinger, one of the primary authors of the National Commission on Correctional Health Care’s report The Health Status of SoonTo-Be-Released Inmates, told the Commission that while studying prison
health care he had learned that “this was all about . . . my health and yours
and the health of our families because, among other things, the burden of
illness among inmates is really very, very extraordinary.” He was referring
to the very high prevalence among prisoners of communicable diseases
such as tuberculosis, hepatitis, HIV, sexually transmitted diseases, and most
recently on the rise—drug resistant staph infections. Since many of these
diseases disproportionately affect African-Americans and Latinos, our
failure to identify and treat disease in correctional institutions puts these
communities at particular risk.
The NCCHC report demonstrates that proper screening and treatment
of infectious diseases in prisons and jails would improve public health
(NCCHC 2002). While some public health agencies already work with correctional systems to manage infectious disease, too many county and state
public health departments have not shouldered this responsibility. There are
potentially devastating results when corrections departments do not have
the help and resources to control disease. Conversely, well-designed systems
of disease control can enormously benefit public health and result in tremendous cost savings down the road. For example, in New York City in the
1980s and early 1990s there was an epidemic rise in tuberculosis, including
a dangerous jump in the incidence of multi-drug resistant tuberculosis. The
rise in drug-resistant cases, in particular, was believed by many to be largely
the result of poor treatment in prisons and jails. Research shows a correlation between time spent in jail and tuberculosis infection (Bellin et al. 1993).
With support from the Centers for Disease Control and Prevention, the
city and state’s coordinated response included establishing a Communicable
Disease Unit in the jails at Rikers Island. The effort was a success. Between
1992 and 1998 tuberculosis cases declined 59 percent citywide, and the number of drug-resistant cases declined 91 percent (Shalala 2000).
It is particularly challenging for jails to track infectious diseases without
active assistance from local public health departments. Many people spend
only a day or two in jail, less time than it takes to get results from a tuberculosis or STD test. Given the costs of the tests, jails may be reluctant to
provide them to people who might be released before they can be informed
of the results. In those jails where the local public health agency is involved
in disease testing, that agency can take responsibility for informing people
about their test results and following up with necessary care.

Returning Home with a Disease
People carrying an infectious disease who were
released from prison and jail in 1996.

hepatitis c

1.3 – 1.4 million
hiv /aids

98,000 – 145,000
39,000

hiv

aids

tuberculosis

566,000
12,000*

latent

active

* Estimated number of prisoners released in 1996
who had active TB at some point that year.

source: national commission on correctional
health care, 2002

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47

Public health agencies throughout the country should seize the opportunity to collaborate with correctional systems. Working together and
following national guidelines, they can ensure that infectious diseases are
closely tracked and properly managed through screening, testing, and
treatment inside correctional facilities and continued care after release.

5

End co-payments for medical care. State legislatures should
revoke existing laws that authorize prisoner co-payments for
medical care.
Beginning about a decade ago, under significant pressure from state
lawmakers to control spiraling medical costs, correctional facilities began
charging prisoners co-payments for health care. The trend took off, and
by 1997 legislatures in 33 states had passed laws authorizing prisoner
fees—generally including co-payments—for medical care (NIC February
1997). Co-payments are not designed to offset the expense of a doctor’s
visit, and in some systems the cost of administering the fees is greater
than the money recovered. Rather, co-payments are intended to drive
down medical costs by discouraging prisoners from seeking unnecessary
care and to free up physicians to treat the truly ill. And indeed, research
in 36 states shows that co-payments reduce sick calls between 16 and 50
percent (Stana 2000).
But these fees do much more than discourage the malingerer. They
also have unintended consequences, causing prisoners with legitimate
medical concerns to delay or forego seeking necessary treatment. In the
worst cases, this can lead to unnecessary suffering and death, and can
cause the spread of disease to other prisoners and staff and into the surrounding community. In a study conducted by the Centers for Disease
Control and Prevention to evaluate the cause of outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) in correctional facilities
in Georgia, California, and Texas between 2001 and 2003, co-payments
were singled out as a significant contributor to the spread of these serious
and aggressive skin infections because they discouraged prisoners from
seeking care (CDC 2003).
Most Americans are accustomed to paying a portion of their medical
care. Given the tremendous pressure on corrections administrators to
contain costs and hold prisoners accountable, co-pays in a correctional
facility also seem reasonable. But even small fees can be insurmountable for sick prisoners who have no control over the jobs and wages
available to them (NIC February 1997). The majority of state correctional systems and many jails charge between $2 and $15 for a sick-call
request, a doctor’s visit, and in some systems, for a prescription (NIC
February 1997, NIC September 1997). Meanwhile, not all prisoners have
wage-paying jobs, and the majority of states pay their wage-earning
prisoners less than $1 per hour. At the very low end of the pay scale,
prisoners in Louisiana typically earn two cents per hour—a yearly
wage of $38.40—and in Georgia prisoners earn no wages (Camp 2003).

48

conditions of confinement

In many cases, the actual burden of paying for medical care falls on
prisoners’ families.
Supporters of co-payments argue that systems have been designed to
ensure care for those who really need it. The very best co-pay systems
do not require people with chronic illnesses to pay for routine care or
charge co-payments for providing mental health care, treating infectious diseases, or dispensing medication. They also offer treatment to the
indigent, but the fees can accumulate as debt and are subtracted from
prisoners’ accounts when a family member deposits money or the prisoner
later earns wages. This debt can follow a prisoner for many years, even
after release from prison. While popular with corrections administrators
who are under tremendous pressure from state legislatures to cut costs, copayments can cost the state more in the long run.
The National Commission on Correctional Health Care opposes any
fee-for-service or co-payment program that restricts patient access to care
and offers strict guidelines under which such programs may operate. Many

It is impossible to devise a co-payment program that does not erect
barriers to care that could put the health of individuals in jeopardy,
lead to the spread of disease, and cost more in the long run.
experts privately state, however, that it is impossible to devise a co-payment
program that does not erect barriers to care that could put the health of individuals in jeopardy, lead to the spread of disease, and cost correctional systems
and communities much more in the long run when treatment is delayed.
Against prevailing practice, some people argue that a better way to control medical costs is to ensure full and unimpeded access to primary care.
At the Hampden County Correctional Center in Massachusetts, nurses
visit the housing units every day looking for sick prisoners. Dr. Thomas
Lincoln, the center’s medical director, explains that educating prisoners
about their health and encouraging them to address health concerns immediately is the best way to ease the burden on medical care staff.
Prisoners should never be discouraged from seeking medical care, and
co-payments do just that. The Commission believes the risks are too great
to justify any short-term cost-savings and urges state lawmakers to eliminate co-payments and provide corrections departments with the resources
they need to provide quality medical care in our prisons and jails.

6

Extend Medicaid and Medicare to eligible prisoners. Congress
should change the Medicaid and Medicare rules so that
correctional facilities can receive federal funds to help cover the
costs of providing health care to eligible prisoners. Until Congress
acts, states should ensure that benefits are available to people
immediately upon release.
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49

No U.S. correctional
institution receives
federal Medicaid or
Medicare reimbursement
for health services
provided to prisoners,
even though most
prisoners would qualify
for these benefits and
many were enrolled in
these programs before
incarceration.

50

conditions of confinement

No U.S. correctional institution receives federal Medicaid or Medicare
reimbursement for health services provided to prisoners, even though most
prisoners would qualify for these benefits and many were enrolled in these
programs before incarceration. Medicaid is funded jointly by the federal
and state governments, while Medicare is a federal program. Current law
prevents the federal government from paying its share. Dr. Joe Goldenson
explained the consequences: “The total cost then falls either on the county
in the case of jails or the state in terms of state prisons, and, you know,
except for a cost-saving factor on the part of the federal government, there
really is no reason that should happen, and it places correctional institutions at a real disadvantage in terms of having access to funding that’s
available to everyone else for health care.”
Just like any other community health-care provider, correctional agencies should be reimbursed for the cost of providing medical and mental
health services to people who are Medicaid and Medicare eligible. And
as a positive corollary, the process of certifying correctional facilities as
Medicaid providers would raise the quality of care in facilities where it is
currently substandard. One example may demonstrate how a continued
public health investment for prisoners can benefit everyone and reduce
costs in the long run. Currently, many prisoners with hepatitis C do not
receive treatment because correctional facilities cannot afford to provide
anti-viral medication for everyone likely to benefit from it (NCCHC
2002, Allen 2003). Instead, the public health system pays a much larger
cost down the road when those untreated prisoners are released and are
more likely to require liver transplants because they did not receive treatment earlier. With funding from Medicaid or Medicare, facilities would
be able to treat nearly all infected prisoners when it is medically appropriate, most likely to benefit them, and most cost-effective.
Continuing Medicaid and Medicare reimbursement throughout the
period of incarceration also would promote continuity of care after release. This is an enormous public health issue, as many of the millions
of people released each year—including those with mental illnesses and
infectious or chronic diseases—have no way to pay for treatment or medication until they are returned to the Medicaid or Medicare rolls weeks or
months later. Arthur Wallenstein, who directs corrections in Montgomery
County, Maryland, exclaimed, “This is an unbelievable issue, and I hope
the Commission understands it.” He went on to explain that benefits for
people in jail—even those not yet convicted of a crime but unable to pay
bail—are “suspended the day they walk in and, in many cases, revoked, not
suspended.” Even before the federal rules are changed, states can—some
already do—ensure continuity of care by suspending rather than terminating benefits during incarceration and then making benefits available
immediately upon release. The National Commission on Correctional
Health Care endorses this approach (NCCHC 2002).
Incarceration is no reason for cutting off public funds for health care.
Medicaid and Medicare reimbursement would shift billions of dollars in

costs from states and localities to the federal government. But it is a shift
that makes sense. Given the constitutional mandate to care for prisoners,
the public health consequences of failing to do so, and the huge burden of
correctional health care on states and localities, reimbursing corrections
departments with federal funds for the cost of prisoners’ medical care is
in everyone’s best interest. And until Congress acts, states should ensure
continuity of care by suspending—never terminating—benefits, and by arranging for the immediate availability of benefits on a prisoner’s release.

provide health care that protects everyone:
recommendations recap
1. Partner with health providers from the community. Departments of corrections
and health providers from the community should join together in the common
project of delivering high-quality health care that protects prisoners and the
public.
2. Build real partnerships within facilities. Corrections administrators and officers
must develop collaborative working relationships with those who provide health
care to prisoners.
3. Commit to caring for persons with mental illness. Legislators and executive
branch officials, including corrections administrators, need to commit adequate
resources to identify and treat mentally ill prisoners and, simultaneously, to
reduce the number of people with mental illness in prisons and jails.
4. Screen, test, and treat for infectious disease. Every U.S. prison and jail should
screen, test, and treat for infectious diseases under the oversight of public health
authorities and in compliance with national guidelines and ensure continuity of
care upon release.
5. End co-payments for medical care. State legislatures should revoke existing laws
that authorize prisoner co-payments for medical care.
6. Extend Medicaid and Medicare to eligible prisoners. Congress should change
the Medicaid and Medicare rules so that correctional facilities can receive federal
funds to help cover the costs of providing health care to eligible prisoners.
Until Congress acts, states should ensure that benefits are available to people
immediately upon release.

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51

Limit Segregation

recommendations
1.	 Make segregation a last resort and a
more productive form of confinement,
and stop releasing people directly
from segregation to the streets.
2.	 End conditions of isolation.
3.	 Protect mentally ill prisoners.

52

conditions of confinement

beginning in november, 2002, an investigative reporter 
from USA Today followed nine people released directly from high-security
“segregation” units in Texas prisons, just a few of the approximately 1,200
prisoners the Texas Department of Criminal Justice separates from the
general prison population for reasons of safety. Thirty-one months later,
seven of the nine had served additional time in prison. Adam Morales
is one of them. A gang member, he spent a decade in solitary confinement before his release in 2002. Morales now faces 35 additional years in
segregation for shooting up his apartment while drunk and then trying to
escape from jail. His niece told the reporter that she remembers seeing her
uncle at the local Wal-Mart walking with his back to the walls and avoiding other customers. Psychologist and University of California Professor
Craig Haney, who has interviewed hundreds of prisoners in segregation,
has said that they are “utterly dysfunctional when they get out” and that
family members often ask him to help their relatives adjust to normal life
( Johnson 2005). Texas has since begun a pilot program to smooth the
transition from long-term segregation to the community and is closely
tracking the results.
Separating dangerous or vulnerable individuals from the general prison
population is a necessary part of running a safe correctional facility. In
some systems around the country, however, the drive for safety, coupled
with public demand for tough punishment, has had perverse effects: Prisoners who should be housed at safe distances from particular individuals
or groups of prisoners end up locked in their cells 23 hours a day, every day,
with little opportunity to engage in programming to prepare them for release. People who pose no real threat to anyone and also the mentally ill are
languishing for months or years in high-security units and supermax prisons. And in some places, the environment in segregation is so severe that
people end up completely isolated, living in what can only be described as
torturous conditions. There is also troubling evidence that the distress of
living and working in this environment actually causes violence between
staff and prisoners (see “Diminishing Returns in Safety,” p. 54).
On June 30, 2000, when the federal Bureau of Justice Statistics last collected data from state and federal prisons, approximately 80,000 people
were reported to be confined in segregation units. That is just a fraction of

the state and federal prisoners who spend weeks or months in expensive,
high-security control units over the course of a year, and it does not capture
everyone incarcerated in supermax prisons. And there is no similar data
for local jails. But as an indicator of the use of segregation, the BJS prison
census data from 1995 and 2000 suggest a troubling shift in practice. Over
this five-year period, the growth rate in the number of prisoners housed
in segregation far outpaced the growth rate of the overall prison population: 40 percent compared with 28 percent (BJS 1998, BJS 2004). As lawyer,
scholar, and prison monitor Fred Cohen told the Commission, segregation
is a “regular part of the rhythm of prison life.”
The overreliance on and inappropriate use of segregation hurts individual prisoners and officers. But the consequences are broader than that: The
misuse of segregation works against the process of rehabilitating people
and threatens public safety. Both the problems and their consequences
trouble experts like Fred Cohen as well as many corrections administrators.
Based on their views and experiences, this chapter presents the Commission’s recommendations for placing greater limits on the use of segregation
in America’s prisons and jails.

1

Walter Dickey, former
secretary of the Wisconsin
Department of Corrections,
said that his state’s
supermax prison was
filled with the wrong
people, “the young, the
pathetic, the mentally ill,”

Make segregation a last resort and a more productive form
of confinement, and stop releasing people directly from
and at twice the cost of
segregation to the streets. Tighten admissions criteria and safely
transition people out of segregation as soon as possible. And go
incarceration in a
further: To the extent that safety allows, give prisoners in segregation
opportunities to fully engage in treatment, work, study, and other
maximum security prison.
productive activities, and to feel part of a community.
Placing someone in segregation should be a last resort, a choice made
only after carefully considering other options and only for the purpose of
maintaining safety in the facility. Often that is not the case, however.
Prisoners can end up in “disciplinary” segre­
gation, a form of punishment, for possessing
Disciplinary vs. Administrative Segregation
tobacco or talking back to an officer—rulePrisoners end up in segregation for one of two reasons. Either they are placed in
breaking that poses little or no threat to the
“disciplinary” segregation as a form of punishment for breaking rules in prison,
safety and order of a facility. And this might
or they are classified into “administrative” segregation and supermax prisons
occur before less extreme and costly punishbecause they are assumed to pose a threat to other prisoners and staff or because
ments are considered, such as restricting comthey are especially vulnerable and need to be protected from the general prison
missary, revoking work privileges, and limiting
population or from particular individuals. Even within the already highly controlled
access to mail and phones (Riveland 1999). Beenvironment of a supermax prison, there can be special control units—a form of
tween 1995 and 2000 the daily count of people in
segregation within segregation.
disciplinary segregation increased 68 percent—a
In theory, stays in disciplinary segregation are meant to be relatively
rate of growth more than double the growth rate
brief, lasting just weeks. In practice, that is often not the case. Administrative
of the prison population overall (BJS 1998, BJS
segregation, by contrast, is intended to be long-term, often for the length of an
2004). Equally troubling, stays in disciplinary
entire sentence. When the purpose of segregation is to punish and deter rule
segregation are likely to last for months or even
breaking—and the stay is assumed to be brief—it is more accepted to restrict
years, rather than weeks or days (Correctional
privileges such as access to phones, newspapers, and outdoor recreation. In
Association of New York 2003). This can happen
administrative segregation, additional punishments should not be permitted.
l i m i t s e g r e g at i o n

53

because of the way punishment is meted out. For example, a young prisoner caught with 17 packs of Newport cigarettes—contraband in the nonsmoking jail—was given 15 days in solitary confinement for each pack of
cigarettes, more than eight months altogether.
There has also been an upswing in the use of long-term segregation,
where prisoners are separated from the general prison population because
they pose a danger to others or are vulnerable to attack. This includes “administrative” segregation, where prisoners are classified into control units
within a prison, and also supermax incarceration, special high-security facilities that began to populate the correctional landscape beginning in the
mid-1980s. The actual risk someone presents to
Diminishing Returns in Safety
the prison community should be carefully conBy separating out people who are perceived to be most dangerous or most
sidered before segregating the person for what
vulnerable, corrections administrators aim to prevent violence that would spread
could amount to the entire length of his or her
and multiply throughout their systems. Limited research about the impact of
sentence. Yet just a few years ago, Walter Dickey,
segregation on the safety of correctional systems is not encouraging, however. A
former secretary of the Wisconsin Department of
carefully designed study of correctional systems in Arizona, Illinois, and Minnesota
Corrections, said that his state’s supermax prison
found that segregating prisoners in supermax facilities did little or nothing to lower
was filled with the wrong people, “the young, the
overall violence. Prisoner-on-prisoner violence did not decrease in any of the three
pathetic, the mentally ill,” and at twice the cost
states. Prisoner-on-staff assaults dropped in Illinois, but staff injuries increased in
of incarceration in a maximum security prison—
Arizona, and there was no effect in Minnesota (Briggs et al. 2003). Donald Specter,
$40,000 compared with $20,000 (Zaleski 2001,
who litigates on behalf of prisoners in California, testified that the state’s efforts to
Wisconsin Department of Corrections).
reduce violence systemwide by putting dangerous prisoners in supermax facilities
In some cases, the net has been intentionally
and segregation units was a “failure.” “The level of violence in California has been
widened. Toward the end of the 1990s, officials
going up, notwithstanding these SHUs [Special Housing Units],” he said.
in Virginia quietly expanded eligibility criteria
There also is some evidence that officers who work in SHUs are more likely to be
for Red Onion and Wallens Ridge—brand new,
assaulted. One study found that 71 percent of assaults on staff occurred in a control
technologically advanced supermax facilities—
unit that housed less than 10 percent of the facility’s prisoners (Kratcoski 1988).
when there were more cells than dangerous prisIt may be that segregated prisoners, many of whom have histories of violence,
oners to fill them. “[T]he ‘worst of the worst’ had
pose a greater threat to officers than prisoners in the general population. But it
come to be a meaningless phrase,” author Joseph
may also be true that harsh living conditions in segregation only exacerbate those
Hallinan writes. “It included those who had been
tendencies. In other words, when segregation approaches or becomes isolation, it
disruptive and those who had not, those who
can make worse the very problem it is designed to solve.
had committed horrible crimes and those who
Veteran officer Gary Harkins described an environment in the Intensive
had harmed no one.… Wallens Ridge would
Management Unit at the Oregon State Penitentiary where the lack of meaningful
hold them all” (Hallinan 2003). Researchers beinteraction “creates an ‘us versus them’ mentality on both sides.” Former
lieve this kind of inappropriate classification of
Mississippi prison Warden Donald Cabana, agrees: “The environment . . . actually
prisoners is not uncommon (Kurki and Morris
increases the levels of hostility and anger among inmates and staff alike,” he told
2001, Human Rights Watch 2000, Riveland 1999,
the Commission.
Wilkinson v. Austin 2005).
Solitary confinement is not the only option. Fred Cohen, a lawyer and scholar
Net-widening is not limited to supermax priswho has monitored correctional systems across the country, testified that in Europe
ons. Former Minnesota prison Warden James
dangerous prisoners are housed in small units of 10 people and receive special
Bruton told the Commission, “There are states
programming. And according to Steve Martin, who has visited and inspected over
in this country that [segregate] prisoners simply
500 facilities, this is an approach that can and does work in the United States:
because they have a gang affiliation, whether or
dangerous prisoners can be safely managed without isolating them in locked cells
not they have done anything in the prison, and
23 hours a day.
I happen to think that’s wrong.” In some cases,
54

conditions of confinement

African-American and Latino prisoners are being unfairly labeled as gang
members—a practice that only increases tendencies in some systems and
facilities to disproportionately house minority prisoners in segregation
units (Kupers 1999). Addressing the appropriate use of segregation requires
sensitivity to why we perceive some as dangerous and how we feel about
isolating them. Moreover, sociologist and former prison gang member
Douglas Thompkins explained that the disproportionate segregation of
racial minorities can actually encourage both prisoners and staff to engage
in gang-like activity for self-protection.
Thousands of people today are living in segregation, often in extremely
harsh conditions, with no clear understanding of when they might be moved
to the general prison population. In their study of a supermax prison in
Tamms, Illinois, researcher Leena Kurki and criminologist Norval Morris noted a lack of regular and meaningful internal reviews to determine
whether individual prisoners must remain segregated (Kurki and Morris
2001). Others have decried the absence of formal hearings and appeals where
prisoners can defend themselves against being transferred to or held in segregation (Haney and Lynch 1997, Toch 2001).
The Commission heard that prisoners, their families, and the community
often lack confidence that correctional facilities
keep the “right” people in segregation and the
From Solitary Confinement Straight to the Streets
“wrong” people out. Daud Tulam, a former prisAcross the country, prisoners are being released into the community directly from
oner who spent 18 years in segregation in differsegregation—in some cases, after spending years in solitary confinement. There
ent New Jersey prisons, told the Commission
are no national recidivism data for people released directly from segregation to
that the required 90-day reviews were “a sham,
the community, but a large study of former prisoners in Washington suggests that
with no real investigation,” and that after a few
the odds of success are poor indeed. Researchers tracked rearrest rates among
years he stopped participating in the review propeople released from prison in 1997 and 1998, a total of 8,000 former prisoners.
cess, feeling that he would never be transferred
Two hundred and forty-two of them had spent at least three continuous months
out of the control unit.
in segregation, and most had been housed in segregation for much longer. Those
James Bruton explained to the Commission
who had been segregated were somewhat more likely than the others to commit
that the sheer volume of people in segregation
new felonies. And among the repeat offenders, formerly segregated prisoners were
makes it difficult for departments of corrections
much more likely to commit violent crimes.
to conduct regular and meaningful reviews. CorAt first glance, this seems to make sense: People who are violent before
rectional facilities also lack the resources and
being incarcerated, which is true of many but not all prisoners in segregation,
support to develop programs and incentives that
may resume violent behavior after release. But an additional finding from the
encourage prisoners to behave in ways that make
study throws that conclusion into doubt. People who were released directly
transfer out of segregation likely, according to
from segregation had a much higher rate of recidivism than individuals who
Steve Martin, who was formerly a corrections ofspent some time in the normal prison setting before returning to the community:
ficer and general counsel to the Texas Department
64 percent compared with 41 percent. That finding suggests a link between
of Criminal Justice and has visited or inspected
recidivism and the difficult living conditions in segregation, where good
more than 500 facilities around the country.
rehabilitative and transitional programming are less available (Lovell and Johnson
The American Correctional Association re2004, Commonwealth of Massachusetts Governor’s Commission on Corrections
quires accredited facilities to have a documented
Reform 2004, Petersilia 2003). As distinguished criminologist Hans Toch cautions,
review process and to conduct reviews every 30
“Supermax prisons may turn out to be crucibles and breeding grounds of violent
recidivism. . . . [Prisoners] may become ‘the worst of the worst’ because they have
days for the purpose of determining “whether
the reasons for the placement still exist” (ACA
been dealt with as such” (Toch 2001).
l i m i t s e g r e g at i o n

55

2003, Standard 4-4253 and Standards 4-4251 through 4-4256). But the
ACA’s standards do not describe the features of a meaningful review process. Nor does the ACA explicitly suggest that corrections administrators
should use these reviews to move people out of segregation as soon as
possible. These standards could be strengthened by making them more
detailed and goal-oriented. The ACA also has standards that require an
environment in long-term segregation where prisoners participate in educational programming and recreational activities (Standard 4-4273). More
correctional facilities should meet those standards.
There is growing consensus that correctional systems should rely less on
segregation, using it only when absolutely necessary to protect prisoners
and staff—and that further reforms are needed. Keeping people locked
down for hours on end is counter-productive in the long run. To the extent
that safety allows, prisoners in segregation should have opportunities to
better themselves through treatment, work, and study, and to feel part of
a community, even if it is a highly controlled community.
To reduce the number of segregated prisoners, corrections administrators
must tighten admissions criteria and create a safe and meaningful process

Increase in Segregation Outpaces
Growth in Prison Population

68%

rates of growth
1995–2000

40%
31%

28%

8%
prison
population

total in
segregation

Administrative
Segregation

Protective
Custody

Disciplinary
Segregation

types of segregation

census figures
prison
population

1995*
2000+

conditions of confinement

Administrative
Segregation

Protective
Custody

Disciplinary
Segregation

1,023,572

57,591

27,972

10,006

19,973

1,305,253

80,870

36,499

10,785

33,586

*Count on June 30, 1995
+
Count on June 30, 2000

56

total in
segregation

source: bureau of justice statistics

for moving people out of segregation as soon as possible. That transitional
process requires gradually increasing a person’s interactions with other prisoners and staff, so that formerly segregated individuals become accustomed
to living with others in a less controlled environment. And for prisoners nearing the end of their sentence, the transition should include a prerelease transfer to the general prison population where they can participate
in mainstream programming as well as targeted reentry preparation.

2

End conditions of isolation. Ensure that segregated prisoners
have regular and meaningful human contact and are free from
extreme physical conditions that cause lasting harm.
“There are offenders who need to be highly controlled at all times,”
former Minnesota prison Warden James Bruton explained. “But they
still need contact with other people. They still need a reason to approach
each day with a positive attitude—a phone call or visit from a loved one,
a magazine or newspaper. They still need to feel like human beings.” In
Bruton’s opinion, meeting those basic human needs is the key to safety.
And locking people in stark cells 23 hours a day without incentives for
good behavior is the wrong approach.
Conditions in segregation vary across the
country. In the most severe conditions—which
The Torment of Isolation
are more likely to occur in disciplinary segregaI never seen the sky, or felt the warmth of the sun, or a breeze pass by me, the trees
tion units and supermax prisons—individuals
and grass or a rain drop. I never knew how painful it could be to be denied nature
are locked down 23 or 24 hours a day in small
itself. I had a small narrow window which does not open, but all I could see was
cells between 48 and 80 square feet with no
brick walls and nothing more. I remember from those brick walls was a small plant
natural light, no control over the electric light
growing from within the cracks of the brick, that was my only part of nature that
in their cells, and no view outside of their cells.
gave me hope. As the wind would blow against the leaves of this plant, I would
They have no contact with other prisoners—even
actually close my eyes and pretend this very wind was blowing against my face. I
verbal—and no meaningful contact with staff.
know it sounds crazy, but it was the only part of nature that I had.
They may be able to spend up to an hour every
Then one day I could not stand it and I so desperately need to feel real air, so I
other day alone in a concrete exercise pen. Access
started to scrape the seal from the window with my finger tips, I was determined
to books and writing materials is limited; radio
to make an opening.
and television are banned; calls to and visits with
For three months of every day I scraped and scraped where my fingers bleeded,
family are very infrequent, when permitted at all.
but I managed to make a very small opening and I only had room to place one side
While there is no national data indicating how
of my nose against this opening at a time and I would take such a deep breath
often segregation involves conditions of isolation,
where I was finally able to inhale a very small amount of air but it was all I needed
in order to survive . . . .
experts who have traveled the country and seen
systems up close believe that isolation is not a
The officers there felt sorry for me and they would bring me paper and a pen to
rare occurrence.
keep myself busy with being I had nothing and there is where I started to doodle
The American Correctional Association
on paper and from there was how I became an artist. I never in my life knew how to
has standards that prohibit the most punishdraw, I couldn’t draw a heart to save myself, but after three years of this madness
ing physical conditions in segregation. Cells
of being locked like an animal instead of letting it get to me I put all my pains on
in accredited facilities, for example, must have
paper and before I knew it I had art!
windows (Standard 4-4148). Cumulatively, the
—Excerpted from a letter dated July 15, 2001, to Bonnie Kerness, Director of the
standards aim to prohibit total isolation, where
American Friends Service Committee’s Prison Watch. The author is a 45- year-old
prisoners almost never encounter another
mother of three who was housed in the segregation unit of a New Jersey prison.
l i m i t s e g r e g at i o n

57

person. The standards should be strengthened, however, to require regular
and meaningful human contact.
“I’ve spoken with people who begin to cut themselves, just so that they
can feel something,” said Bonnie Kerness when she testified before the
Commission. Kerness is associate director of the American Friends Service
Committee’s Prison Watch. She has been monitoring conditions in segregation nationally since the early 1980s and receives hundreds of letters every

In the most severe conditions—which are more likely to occur in
disciplinary segregation units and supermax prisons—individuals
are locked down 23 or 24 hours a day in small cells between 48 and 80
square feet with no natural light, no control over the electric light in
their cells, and no view outside of their cells.
year from or about prisoners in these control units. A study of Virginia
prisons supports such personal accounts. Half the documented incidents
of self-mutilation in 1985 took place in the segregation units (Haney and
Lynch 1997).
In the mid-1980s, psychiatrist Stuart Grassian studied a small group of
Massachusetts prisoners who had been living in isolation. He identified
a constellation of symptoms that includes overwhelming anxiety, confusion and hallucination, and sudden violent and self-destructive outbursts.
Because those prisoners were confined in the Special Housing Unit, he
called the effects “SHU syndrome” (Grassian 1983). Other researchers,
before and after Grassian, have observed the same responses (Brodsky and
Scogin 1988, Fisher 1994, Haney 1993, Haney 2003, Kupers 1999, Rhodes
2004, Toch 1975).
In 1997, psychologists Craig Haney and Mona Lynch reviewed dozens
of studies conducted since the 1970s and concluded that there was not
a single study of non-voluntary solitary confinement for more than 10
days that did not document negative psychiatric symptoms in its subjects
(Haney and Lynch 1997). Two years later in Ruiz v. Johnson, a federal
court in Texas ruled that conditions in that state’s administrative segregation units—“extreme deprivations which cause profound and obvious
psychological pain and suffering”—violated the Constitution’s prohibition against cruel and unusual punishment. While experts believe that
prolonged isolation is always harmful, they note that very short-term
isolation—for less than 24 hours—can be used in extreme circumstances
as a therapeutic intervention to stabilize someone who is completely
out of control and to prevent harm to self or others. For isolation to
fulfill a therapeutic purpose, as opposed to managing or punishing the
58

conditions of confinement

prisoner, a trained mental health professional must be involved throughout the process (see “Protect mentally ill prisoners” below).
Extreme conditions in segregation also take a toll on the men and
women who work every day in these environments. Bonnie Kerness recalled what one New Jersey corrections officer told her: “‘When I see a
human being who is reduced to throwing feces and urine, it wears me
down,’ he said. ‘I am breathing the same canned air, sitting under the same
fluorescent lights, listening to the same noises. I don’t believe this is good
for officers or good for the prisoners.’”
There are signals that the fascination with expensive and soul-destroying
supermax prisons is waning. “I was in a supermax last week with 240 inmates built for 500,” Fred Cohen told the Commission, “and there were
inmates jogging on empty cell blocks, playing handball against walls.”
What’s quietly happening, he reports, is that “because you can’t say to the
legislators we never should have built that supermax, you use it for different purposes, even if you don’t rename it.” In light of all the evidence, we
should accelerate this trend: stop isolating people and ensure that segregated prisoners have regular and meaningful human contact and are free
from extreme physical conditions that can cause lasting harm.

Missing Data
•	The number of people held in
	 conditions of isolation
•	How often jails rely on segregation
•	How much time on average
	 prisoners spend in segregation
•	The ethnic, racial, and gender
	 make-up of segregated prisoners

3

Protect mentally ill prisoners. Prisoners with a mental illness
that would make them particularly vulnerable to conditions in
segregation must be housed in secure therapeutic units. Facilities
need rigorous screening and assessment tools to ensure the
proper treatment of prisoners who are both mentally ill and difficult
to control.
Gary Harkins, a corrections officer for 25 years at the maximum security Oregon State Penitentiary, told the Commission, “It’s not unusual
to have up to one half of the segregation beds occupied by mentally ill
inmates.” In the year 2000, 30 percent of prisoners in Washington’s Intensive Management Units had a serious mental illness, compared with
illness rates among the general prisoner population ranging from 10 to
15 percent (Lovell et al. 2000). In 1999 half the prisoners at the Wabash
Valley Special Housing Unit in Indiana had a diagnosed mental disorder
(Kupers 1999).
A record 44 prisoners killed themselves in California prisons in 2005,
and 70 percent of those suicides occurred in disciplinary segregation units
(Thompson 2006). In a national study of 401 suicides that took place
in U.S. jails in 1986—one of the largest studies of its kind—two out of
every three people who committed suicide were being held in a control
unit (Hayes and Rowan 1988).
The presence of schizophrenia, other psychotic disorders, and major
depression coupled with suicidal tendencies can make it impossible for a
person to cope with the conditions in segregation. And these are not the
only mental illnesses that can make life in segregation unbearable and
harmful. Experts agree that prisoners with post-traumatic stress disorder,
l i m i t s e g r e g at i o n

59

certain phobias, those who are developmentally disabled, and people with
severe personality disorders where there is also a history of or significant potential for psychotic behavior under stress may be poor candidates
for segregation. Research shows that an extended stay in segregation is
harmful to such individuals and makes it more difficult to treat them successfully once they return to the general prison population or are released
to the community (Haney 2003).
While prisoners with serious mental illnesses need to be in secure
therapeutic units inside prisons and jails, they are likely to end up in disciplinary segregation if they display the kinds of disruptive, troublesome, or
self-injurious behavior that corrections workers tend to punish or manage
using segregation. “Many of these people who are said to be the ‘worst of
the worst’ are simply the wretched of the earth. They’re sick people,” Dr.
Stuart Grassian told the Commission. He described a “revolving door”
phenomenon where mentally ill prisoners in the most isolating conditions
become so acutely ill that they end up being committed to a psychiatric
hospital, where they recover just enough to be sent back to the control unit.
And the cycle begins again.
Three federal courts have determined that some conditions of isolation
may constitute cruel and unusual punishment when the individuals being
held in those conditions are mentally ill (Jones ‘El
In Minnesota, A Prison Community
v. Berge 2001, Ruiz v. Johnson 1999, and Madrid
Even for Dangerous Prisoners
v. Gomez 1995). The American Correctional As“I’m a very big believer in control and security. You have to have it, but it goes with
sociation warns that “inmates whose movements
dignity and respect.” These are the words of James Bruton, former Warden of the
are restricted in segregation units may develop
maximum security Oak Park Heights prison in Minnesota—a facility that exists in
symptoms of acute anxiety or other mental problieu of a traditional supermax prison. He told the Commission that even the most
lems” and recommends regular psychological asdangerous prisoners need and are assured human contact, natural light and other
sessments of these prisoners (Standard 4-4256).
sensory stimulation, and regular exercise. Perhaps most revolutionary, few people
The ACA standards should be strengthened to
in this high-security prison are locked in their cells during the day.
specify what facilities must do when someone
The lesson of Oak Park Heights is that it is possible to create a secure
with a mental illness ends up in segregation.
environment without resorting to near total social and sensory deprivation. And
In 1997, a federal court in Iowa found that
in Bruton’s opinion it is not only possible, it is the better option: “When you
half the mentally ill prisoners at the Iowa State
have a very distilled population like that, where half of the people that you work
Penitentiary were living in the segregation unit
with every day have killed somebody and 95 percent have hurt somebody, you
(Goff v. Harper 1997). The high-security cellblock
better find a way every day for them to get up in the morning and look forward to
housed so many seriously mentally ill prisoners
something positive or you’ve got big trouble.”
that it was commonly known as the “bug range.”
“I’ve seen many of the high-security prisons, and Oak Park Heights, I believe, is
Iowa has since opened a mental health unit to
the most secure institution ever built anywhere in the world. I truly believe that . . . .
house difficult-to-manage prisoners who would
Twenty-three years of operations, never been a homicide. Twenty-three years of
otherwise be placed in isolation. But when a rash
operations, never been an escape, never been an attempted escape. Very little
of suicides in 2004 suggested a continuing probdrugs inside the institution.”
lem, the Iowa Department of Corrections hired a
“We have a responsibility . . . maybe more so in a high-security prison, to
consultant through the National Institute of Corcreate an environment conducive to rehabilitation for people who want to make
rections to review the situation. Among several
a change in their lives. Why wouldn’t we do that? Remember, 95 percent are
problems, the consultant discovered the departgetting out some day.”
ment’s heavy emphasis on prisoner accountability
60

conditions of confinement

led mentally ill prisoners to be placed in disciplinary segregation for behavior they could not control and to be kept there when their behavior did not
improve (White 2005). Since that review, the department has improved
both policy and practice, and in 2005 there were no suicides in the segregation unit of the Iowa State Penitentiary or any of the state’s prisons.
Iowa is not alone in the effort to divert mentally ill prisoners from segregation units. Corrections administrators in New Mexico, Ohio, Oregon,
Pennsylvania, and other states are doing the same. In many cities and counties around the country, large jails are making similar progress spurred in
part by a promising collaboration of criminal justice, law enforcement, and
mental health treatment and advocacy groups coordinated by the Council
of State Governments (CSG 2002). But even though diversion works, the
mentally ill can end up in therapeutic units where they are locked in their
cells nearly all of the time because facilities lack staffing and other resources to treat them in a less restrictive setting. And too often the severely
mentally ill remain detained in jails simply because there is no space for
them in community-based treatment facilities.
Correctional systems must build on achievements to date and expand
the use of rigorous screening and assessment tools to identify mentally ill
prisoners who cannot cope with the conditions in segregation. Caring for
those who cannot be housed in the general prisoner population requires
investing in secure therapeutic units inside prisons and jails staffed by
mental health professionals who can handle troubled individuals without
locking them in their cells all day. We must also expand the capacity of
community mental health resources to care for mentally ill persons before
they become mentally ill prisoners (see “Commit to caring for persons with
mental illness,” p. 43).

limit segregation: recommendations recap
1.	 Make segregation a last resort and a more productive form of confinement, and
stop releasing people directly from segregation to the streets. Tighten admissions
criteria and safely transition people out of segregation as soon as possible. And go
further: To the extent that safety allows, give prisoners in segregation opportunities
to fully engage in treatment, work, study, and other productive activities, and to feel
part of a community.
2.	 End conditions of isolation. Ensure that segregated prisoners have regular and
meaningful human contact and are free from extreme physical conditions that cause
lasting harm.
3.	 Protect mentally ill prisoners. Prisoners with a mental illness that would make
them particularly vulnerable to conditions in segregation must be housed in secure
therapeutic units. Facilities need rigorous screening and assessment tools to ensure
the proper treatment of prisoners who are both mentally ill and difficult to control.

l i m i t s e g r e g at i o n

61

“We are not knuckle-dragging guards
working in smelly dungeons, and we
do not deserve that reputation.”
Sergeant Gary Harkins,
Oregon State Penitentiary

II. Labor and Leadership
the public rarely thinks about people
in prison and thinks even less often about the
men and women who manage and work in
these same facilities. When we do look closely,
what we see is a poorly understood profession
that shoulders tremendous responsibilities and
faces incredible challenges, usually without
adequate resources and support. Yet this labor
force is responsible for operating jails and prisons

“Prisons that have
wardens who
are proactive,
humane, and
model appropriate
behavior toward
prisoners and
staff reduce the
likelihood of
abusive staff
behavior.”
Patrick McManus,
former corrections
secretary in Kansas

that must safely and humanely accommodate
an estimated 13.5 million people annually.
When corrections professionals fail to meet the
demands of the job, for whatever reason, they
endanger prisoners and officers alike and, at the
extreme, cripple entire facilities. The failures
are felt beyond the facility walls when officers
and prisoners return to their families and their
communities. § This is a tough profession. The

labor and leadership

63

life of a corrections officer can involve long shifts in tense, crowded facilities without enough backup, support, or training—stressful conditions
that take a toll on the workforce both personally and professionally (Finn
2000). Higher up the chain of command, the demands change but they
do not decrease. Many wardens have to run aging and understaffed facilities and deal with a workforce in which experienced officers are likely to
leave the profession for better paying, less stressful jobs just when they
are ready to become good mentors for new recruits. The men and women
who manage entire systems are expected to serve more and more people
with comparatively fewer resources. They are pressured to succeed in the
face of conflicting demands from lawmakers and the public to rehabilitate prisoners but avoid at all costs practices and programs that might
“coddle” them. That most administrators do not buckle under the pressure
and have instead reduced some of the worst forms of violence is a sign
of their professionalism. Their ability to do even better going forward
depends in part on support from lawmakers and the public.
The recommendations for reform outlined in this section are intended
to acknowledge and build on the underlying strengths of the workforce
and its leaders in two broad ways: by improving the institutional culture in correctional facilities and by supporting corrections professionals
at every level. Progress in these areas would provide a foundation for
improving the safety and effectiveness of America’s prisons and jails.
Without improvements in these areas, other reforms recommended in
this report will be less viable.

64

labor and leadership

Change the Culture and
Enhance the Profession
for all their troubles and achievements, corrections 
professionals receive little positive recognition and are denigrated in the
news and popular media. As Lance Corcoran, chief of governmental affairs
for the California Correctional Peace Officers Association, told the Commission, “After a lifetime, 35 years working, you look back on your life’s
work and it’s very difficult to take pride in what you’ve done. Society or the
newspapers or whatever has told you that this is an awful profession.”
These stereotypes, combined with the incredible difficulties of the job,
can lead frontline officers and some corrections administrators to distance
themselves from prisoners and even to view prisoners as less than human.
And there are countless everyday indignities that reinforce perceptions that
prisoners are a lower class of people. This is an attitude many corrections
professionals acquire in their first days of officer training. Former Warden
Jack Cowley told the Commission about a book called The Games Convicts
Play, still used in some systems to train officers. “They’re trained: don’t
touch, don’t even shake hands, don’t call them by their name, call them by
their number,” Cowley recalled.
Cowley fostered a very different kind of culture at the Oklahoma prison
he ran from 1985 to 1993. He is among the many wardens, sheriffs, and
officers who, for both practical and ethical reasons, have tried to create
a humane culture in the correctional facilities where they work. A few of
them, such as Warden Burl Cain of Angola Prison in Louisiana, Sheriff
Michael Hennessey of San Francisco, and Sheriff Michael Ashe of Hampden County, Massachusetts, have reshaped institutions by changing the
underlying culture.
Today there are statewide efforts in places as far apart as Oregon, Arizona, Massachusetts, and Maryland to change the fundamental culture
of prisons. Corrections administrators in these states understand that an
“us versus them” mentality ultimately jeopardizes the safety and health of
prisoners and staff and over time harms the families and communities to
which prisoners and staff belong. Their efforts at culture change should be
supported, imitated, and improved upon so that no one has to live or work
in a dehumanizing environment and so that our correctional facilities
serve the public’s interests. The culture of these institutions cannot change,
however, unless efforts are made to build a highly qualified workforce and

recommendations
1.	 Promote a culture of mutual respect.
2.	 Recruit and retain a qualified corps 	
of officers.
3.	 Support today’s leaders and 	
cultivate the next generation.

c h a n g e t h e c u lt u r e a n d e n h a n c e t h e p r o f e s s i o n

65

to cultivate and support great leaders. The following three recommendations suggest ways to meet all of these goals.

1

Promote a culture of mutual respect. Create a positive culture
in jails and prisons grounded in an ethic of respectful behavior
and interpersonal communication that benefits prisoners and staff.
The relationship between prisoners and corrections officers is at the very
core of the culture of confinement. Too often, that relationship is uncaring
and antagonistic, punctuated by moments of overt hostility, aggression,
and physical violence. “What ultimately makes a correctional institution
work has to do with the hearts and minds and spirits of those who people
it, not with bricks and mortar, shatterproof glass, pre-fab cells or organizational charts,” Sheriff Michael Ashe of Hampden County, Massachusetts,
told the Commission. In an institution where there are “keepers” and
“kept,” where people are held against their will as punishment for behavior
society condemns, it is not surprising that the hearts and minds of prisoners and staff are often set against one another—creating an institutional
environment that is dehumanizing to both prisoners and staff (Franklin
1999). Massachusetts corrections Commissioner Kathleen Dennehy further
explained the roots of abusive behavior. “The conflicting goals of corrections—deterrence, incapacitation, rehabilitation and punishment—have
gone out of balance. People are sentenced to prison as punishment, not
for punishment. Some staff lose sight of that.”
A National Effort at Culture Change
Prisoners who are mistreated become resistant
In an effort to better understand how to change facilities that suffer from the ills
and sometimes hostile. Or as former Minnesota
of a “default” correctional culture of disrespect and even cruelty, the National
Warden James Bruton writes, “Contempt breeds
Institute of Corrections (NIC) in 2003 began an Institutional Culture Initiative.
contempt” (Bruton 2004).
This program is designed to assess individual facilities and offer training and
According to Bruton, cultivating a positive culassistance to promote positive change. Prison wardens and directors of 12 state
ture inside our correctional facilities is more than
systems applied to participate in the NIC initiative. As a group, they requested
merely a “feel good” idea: “Security and control—
help with 59 different problems. Strikingly, only six of those problems were about
given necessities in a prison environment—only
the behavior of prisoners, such as drug use and violence among prisoners. By
become a reality when dignity and respect are
contrast, 32 of the problems were about staff-related issues, including staff sexual
inherent in the process” (Bruton 2004). William
misconduct, staff morale, staff assaults on prisoners, confrontational episodes
Hepner, a longtime trainer of corrections officers
between staff and prisoners, the lack of ethnic diversity among staff, and difficulty
in New Jersey, encouraged the Commission to
recruiting and retaining quality staff. The remaining 21 problems were related to
consider the far-reaching costs of a work envimanagement or leadership, including leadership changes and a convoluted sense
ronment that does not promote mutual respect
of mission (Byrne et al. 2005).
between prisoners and staff: “When you go to
NIC has developed three interventions to promote positive culture change.
work in a place that has a tendency to be conThese interventions, which are not mutually exclusive, focus on training, problem
descending, negative, vulgar, that can show up
solving, and developing and modeling positive values and behaviors from the top
in your life,” Hepner told the Commission. “The
of an institution down. In order to determine which of these interventions can best
expectation of obedience,” he continued, “can
help an institution, NIC first sends an assessment team to the facility to interview
act as a catalyst for violence at home.” In addistaff and managers and to develop a picture of the organization’s culture, and
tion, when officers are under extreme stress or
along with managers of that institution, to choose an appropriate intervention
injured as a result of altercations, they take sick
plan (Byrne et al. 2005).
leave and vacation time, which results in other
6 6     l a b o r a n d l e a d e r s h i p

officers being forced to work overtime (Finn 2000). Reducing hostility and
conflict within a facility is one of the surest ways to boost staff morale and
job performance (Finn 2000). This in part explains why a culture shift that
improves relations between officers and prisoners will also ease tensions
between staff and management (Coyle 2002).
Growing recognition of the role that institutional culture plays in running a safe and healthy facility has led corrections administrators and other
experts in the field to seek concrete ways to make positive changes in the
cultures of their institutions. They are building on work in other fields,
particularly policing, which has developed methods to assess and improve
organizational culture. Culture change requires ongoing efforts to shift
values and behaviors over time and must be understood as a continual
practice, rather than any single event or program.
Dick Franklin from the National Institute of Corrections (NIC) defines
institutional culture as the “product of the values, beliefs, and behaviors of
the members of the prison ‘community’ as expressed in the ways in which
they interact with each other.” According to Franklin, the default culture
in a correctional community is susceptible to a number of serious problems
that negatively affect both prisoners and staff. The two most significant
problems are a failure of prisoners, staff, and management to be able to
identify with each other, and an institutional dehumanization of prisoners
coupled with management strategies that exacerbate this dehumanization.
These problems result in harassing, careless, cruel, and even criminal conduct; racial and gender prejudices and strife; staff infighting; open conflict
between management and labor organizations; abnormal levels of sick
leave; and high rates of staff turnover (Franklin 1999).
Traditional research on safety failures and violence in prisons locates
the source of that violence in the culture and values prisoners bring into
the institution or that develop among prisoners while incarcerated (Byrne
et al. 2005). One way to address the environment in a correctional setting is to work with prisoners to change their attitudes and behaviors.
(For a discussion of the importance of programming, see p. 27.) That
kind of change is more likely to take root and flourish in purposeful facilities, where prisoners are engaged in productive activities. Mary Livers,
Maryland’s deputy secretary for operations, described ambitious plans for
reform in her state. “We are moving from a very restrictive philosophy of
managing offenders to…a culture of safety, dignity, respect, and accountability,” she said. “We’re moving away from having that feeling of being
safe when offenders are all locked up, to one where we’re actually safer
because we have inmates out of their cells, involved in something hopeful
and productive.”
Another approach to institutional change targets the values, decisions,
and behavior of the leaders and staff of the institution. In particular, there
is increasing interest in the role that corrections officers play in setting the
tone of an institution and, thereby, contributing to the behavior of prisoners
(see “A National Effort at Culture Change,” p. 66). This approach focuses

“What ultimately makes
a correctional institution
work has to do with the
hearts and minds and
spirits of those who
people it, not with bricks
and mortar, shatterproof
glass, pre-fab cells or
organizational charts.”
Sheriff Michael Ashe, Hampden County,
Massachusetts

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67

“We’re moving away from
having that feeling of
being safe when offenders
are all locked up, to one
where we’re actually safer
because we have inmates
out of their cells, involved
in something hopeful and
productive.”
Mary Livers, Maryland’s deputy
secretary for operations

6 8     l a b o r a n d l e a d e r s h i p

on staff training, problem solving, and the development of leaders who
embrace and can model positive values and behaviors.
When training is aligned with the goal of changing the culture of an
institution, it includes teaching people how values, beliefs, and behavior
contribute to that culture. In particular, training for all staff should convey
an ethical code of conduct that recognizes the inherent dignity of all individuals, that emphasizes respect for others, and that teaches a broad range
of interpersonal skills and de-escalation techniques needed to put that code
of conduct into practice every day in culturally and racially diverse environments. Many training programs across the country already cover ethics and
communication. But according to Elaine Lord, who ran a women’s prison
in New York, those issues and skills are often viewed as special topics, addressed in brief and divorced from all other areas of training. Most training,
according to Lord, “revolves around use of force and weapons, and training
for serious emergencies, including escapes, disturbances, or riots,” with too
little time spent teaching interpersonal skills.
It is also essential that staff take responsibility for solving problems in
the institution. This not only creates a more positive work environment, it
also increases the chances that staff will feel accountable to the institution’s
rules and model positive behavior. According to Kathleen Dennehy, “We
know that many offenders go through life believing that rules and laws
don’t apply to them. If the system in which they are incarcerated lacks
integrity and moral order, their notions regarding law and order are simply
reinforced. I am of the strong opinion that corrections staff should be the
very best people prisoners encounter… If staff don’t follow the rules, there
is no hope for intervention or for changing inmate behavior in the long
term.” California corrections Secretary Roderick Hickman similarly told
the Commission, “One of the things that I do as a secretary on an ongoing
basis is work very, very diligently with my staff so that they understand that
their culture, their ethics, their values are one of the most important things
they bring with them each and every day that they walk in the prisons of
California and supervise offenders.”
Because correctional facilities are hierarchical by nature, efforts to improve the institutional culture must come from the top, and leaders need
proven strategies to accomplish this goal. As Sheriff Michael Ashe told
the Commission, “Any successful correctional organization must be infused with, and guided by, a vision of what it seeks to be and, indeed,
what it seeks not to be.” Patrick McManus, former corrections secretary
in Kansas, echoed Ashe’s sentiment. “Prisons that have wardens who are
proactive, humane, and model appropriate behavior toward prisoners and
staff reduce the likelihood of abusive staff behavior,” he told the Commission, suggesting that the behavior of these chief officials affects those who
work directly under them, who in turn influence the officers they supervise.
McManus worked with Andrew Coyle from the International Centre for
Prison Studies to develop A Human Rights Approach to Prison Management and explained to the Commission that reform-minded corrections

administrators around the world are looking for guidance in how to develop more humane correctional environments.
There are other issues that must be addressed for positive change to
happen. Consistently fair treatment in correctional institutions cannot be
achieved without understanding how race, ethnicity, and other cultural
factors influence perceptions of others. Jack Beck, a lawyer who runs
the Prison Visiting Project of the Correctional Association of New York,
described the barriers to creating a culture of respect in some of New
York’s rural prisons: “[T]he only people of color [officers] see have been
convicted of a crime, and they’re in an environment where they have total
control over that person and there’s no respect.” Where there are stark
differences in race and culture between officers and prisoners, it takes real
effort on the part of corrections staff to understand and effectively communicate with prisoners. Again, pre-service and ongoing training are critical. That training must dig deep into ingrained
conceptions about people from different races,
The Daily Indignities
cultures, and neighborhoods. In prisons where
In 1985 I arrived as warden of the Joseph Harp Correction Center, a 900-bed highstaff are committed to an ethic of mutual respect,
medium male facility in central Oklahoma, and walked the yard in my jeans before
Beck explained, prisoners say there is less vioanyone was really acquainted with me. On this particular day I decided to eat
lence. Along with training, diversity among staff
breakfast with the inmates. Food was delivered from a central kitchen and served
is important as it offers a broader view of people
on each living unit of approximately 160 inmates. The men would line up with their
from different backgrounds.
trays and I noticed that some would pick up a spoon while others had their own
Changing institutional culture requires assess(which was against the rule). The food that morning was okay as I recall: pancakes,
ing the values, beliefs, and behavior of manageeggs, and sausage.
ment, staff, and prisoners in an institution and
As I carried my tray of food, following the man in front of me who, like me, did
then developing a plan to address problems. That
not have his “personal” spoon, we walked over to the slop bucket where the trays
plan must include training for staff and manwere dumped. Beside the slop bucket was a small stainless steel pot in which
agers that emphasizes communication, cultural
those men who had completed their meal had deposited their dirty spoons. I
sensitivity, and constructive problem solving. The
watched with complete disgust as the man in front of me fished around in the
plan also must include strategies to address the
cold, slimy mush until he found a spoon. I was ashamed that we would allow
challenges leaders face, from hiring a diverse and
this to happen, but at that moment I was more concerned about having to follow
well-qualified staff to modeling the kind of besuit and reach my hand into the muck. I did and washed it the best I could in the
havior they want to see in their staff. The process
“water” and proceeded to my seat. I certainly didn’t want to use the spoon but
also requires regular monitoring and evaluation
greater was my desire to take what was given as we expected the men to do. It
to ensure that change happens and is sustained.
was immediately apparent to me why others had their personal spoons, which I
The Commission urges corrections leaders to
later found could be “purchased” from one of the men who worked in the kitchen
assess the culture of their institutions and to profor several packs of smokes.
mote a culture of mutual respect in ways that are
Did the staff observing the feeding process abuse the inmates by allowing
proven to work. Serious efforts at values-driven
such unsanitary conditions to exist? Suffice it to say they never ran out of clean
culture change, such as that of the National
spoons again! There are many such incidents, which occur each day in our
Institute of Corrections, should be supported.
prisons. These are the conditions that perpetuate the failure of our system to
These initiatives should be independently evalu“correct.” From an inmate’s point of view, if the staff would allow such things to
ated to determine whether they achieve their
happen, why should they care themselves? [They] just do their time the best way
goals and how they might be refined. Correcthey can and get out. Never really thinking about what they are going to do once
released. Life in prison just becomes days of survival. 		
tions leaders should tap into NIC’s resources, as
—Jack Cowley
well as resources developed by organizations like
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69

the International Centre for Prison Studies and associations of corrections
professionals, and seek the advice and assistance necessary to run safer and
more humane institutions.

2

Recruit and retain a qualified corps of officers. Enact changes
at the state and local levels to advance the recruitment and
retention of a high quality, diverse workforce and otherwise further
the professionalism of the workforce.
Throughout the course of the Commission’s work, corrections officers
lamented that they are not viewed with the same respect as other law enforcement officials. As Sergeant Gary Harkins from Oregon stated, “We
are not knuckle-dragging guards working in smelly dungeons, and we do
not deserve that reputation.” North Carolina Corrections Secretary Theodis Beck, echoed that sentiment: “We have come a long way, from prison
guard to correctional officer.” Beck testified that officers in his state are
better trained and more professional and dedicated than ever before. Yet,
the highly publicized actions of a minority of negligent and abusive officers
continue to demean the entire profession. To ensure safe and abuse-free
prisons and jails, and to promote better public safety and public health
outcomes of incarceration, we must recruit and retain high quality officers
and enhance the professionalism of the workforce in other ways.
The corrections profession is an integral part of the American criminal
justice system. The 400,000 corrections officers
Basic Training
working in U.S. prisons and jails play a large role
In just one decade—1994 to 2004—the U.S. prisoner population expanded by more
in determining how incarceration affects the
than half a million people (BJS 2004). Prisons and jails hired tens of thousands of
roughly 13.5 million people who are locked up
new officers and struggled to adequately train them for an increasingly demanding
over the course of a year. Yet the officer corps
job. Training for corrections officers is one of the most important ways to promote
is an extraordinarily unstable workforce. Gary
safety in prisons and jails.
Harkins told the Commission that nearly twoWhile good training alone cannot make a hard job easy, it can prepare officers
thirds of officers in Oregon have less than five
for the challenges they will inevitably face and cultivate the knowledge, skills,
years’ experience on the job, and 20 percent have
and confidence they need to respond appropriately in difficult situations. As
been on duty for 18 months or less. Over the
Massachusetts corrections Commissioner Kathleen Dennehy explained to the
course of a decade, according to a 2003 study by
Commission, “Experienced, well-trained officers can identify subtle changes [in
the American Correctional Association, an estian inmate] well before the inmate may even be aware. This quick intervention can
mated 490,000 corrections positions will have to
reduce the likelihood of the inmate harming [him- or her-] self or others.”
be filled—the result of new jobs created and an
Basic training for officers varies widely from state to state. The amount of
average annual staff turnover rate of 16 percent.
training required for new recruits ranges from three weeks to two months or longer.
Under present conditions, correctional systems
The mixture of pre-service and on-site training also is uneven, and requirements
around the country face “serious difficulties in refor continuing on-the-job training vary from 40 hours per year in some states to
cruiting and retaining an adequate staff of prop40 hours every four years in others to no mandatory continuing education at all in
erly qualified corrections officers” (ACA 2004).
some states. The American Correctional Association standards require 120 hours
There are two major obstacles to recruiting
of training in an officer’s first year and 40 hours per year thereafter (Standard
good people: low wages and low prestige. The
4-4084). The training academies themselves differ among states, and only 16
ACA study points to a salary scale below what
nationwide have been accredited as Certified Training Academies by the American
police agencies offer and lower than other emCorrectional Association.
ployers who recruit from the same workforce
7 0     l a b o r a n d l e a d e r s h i p

pool. Professor James Marquart, Director of the Crime and Justice Studies
Program at the University of Texas at Dallas, explained how low wages force
correctional systems in some regions to compete with Wal-Mart and other
large retailers for workers. He concluded that corrections has “exhausted the
labor pool for competent staff ” at current wage levels. The starting salary for
corrections officers varies widely from state to state, with Louisiana paying
the lowest salary at $15,324, and New Jersey the highest at $36,850 (ACA
2004). There is some correlation between pay and turnover: States with the
lowest salaries generally have the highest turnover rates. Rates of annual
turnover range from a low of four percent in Massachusetts, which pays

Low wages force correctional systems in some regions to compete 	
with Wal-Mart and other large retailers for workers.
its entry-level officers $35,699 per year, to a high of 41 percent in Louisiana
(ACA 2004). Better pay, commensurate with that of other law enforcement
officers, is a necessary part of retaining staff and building the experience,
skills, and capacity of the workforce to meet the significant challenges associated with operating safe and effective correctional facilities.
Of course, low pay is not the only reason why America’s prisons and
jails have trouble finding and keeping qualified corrections professionals.
The ACA study also found that demanding hours, inadequate benefits, and
stress contribute to high turnover in the corrections profession. And witness after witness told the Commission that it boils down to a feeling of
low esteem and an absence of respect. As Robert Delprino, a professor of
psychology at Buffalo State College, explained to the Commission, many
people do not want to admit that they work in a prison or jail. “They’d rather
just say ‘I work for the state,’” Delprino testified. “You know, think about
it,” he continued, “When you talk to children, they want to grow up to be
a police officer or firefighter. How many children say they want to grow up
to be a correctional officer?” These problems feed each other: Low wages,
difficult working conditions, and low esteem deprive systems of adequate
staffing; inadequate staffing leads to mandatory overtime and unpredictable
shifts, which in turn lead to high turnover and the need to hire more officers.
This vicious cycle affects safety and other conditions in prisons and jails.
One approach to boosting officers’ esteem, while also making the profession more accountable, is to expand the use of statewide systems to certify
and decertify corrections officers. St. Louis University Law School Professor Roger Goldman, a nationally recognized expert on police licensing,
told the Commission that states should treat criminal justice professionals
just like doctors and lawyers, by making their employment conditional
upon a valid license or certification. Half of the states in the country, however, lack a formal process for certifying qualified corrections officers and
decertifying those who violate the law or rules of professional conduct.
Additionally, there is no national-level mechanism to record and share such

At the Bottom of the Pay Scale
Average Annual Wages for Line Officers
in Public Safety Professions
police officer
$46,600

probation officer
$43,020

fire fighter
$39,980

corrections officer
$36,160
source: u.s. department of labor,
bureau of labor statistics, november 2004

c h a n g e t h e c u lt u r e a n d e n h a n c e t h e p r o f e s s i o n

71

Prisoner and Officer Demographics,
2000
state prisons
african-american

other 3
latino

white

46%

36

prisoners
23%

15

65

officers

8 4

men

women
94%

prisoners
officers

6

76%

24

jails
other 2
latino

african-american white
41%

42

prisoners
26%

men

officers*

8 1

65

officers *

prisoners

15

women
89%
72%

*Data for officers in jails is from 1999.

source: bureau of justice statistics

7 2     l a b o r a n d l e a d e r s h i p

11
28

information among local jurisdictions and states. Thus, dangerous officers
can find employment in different facilities and systems because their past
behavior is not known to new employers.
As a first step to ensuring that offending officers are not employed in
other jurisdictions, states could share information in a national corrections
officer databank, similar to the national databank for health-care practitioners. A repository of basic information about every corrections officer
employed within the state—name, social security number, and current place
of employment—would enable conscientious correctional agencies to check
the employment history of someone applying for a job and to contact the
applicant’s previous employers. As more states begin certifying and decertifying officers, the databank would include officers’ certification status. Such a
national databank might be created by expanding the National Decertification Database administered by the International Association of Directors of
Law Enforcement Standards and Training (IADLEST). As of August 2005,
only 19 states were submitting information to this database (Franklin 2005).
Corrections officers deserve a professional status equal to that of other law
enforcement professionals, and correctional agencies should have the tools to
know more about the people they are considering for employment.
Part of building a highly capable corps of officers involves recruiting
and retaining a culturally diverse workforce. The percentage of the workforce that is African-American and Latino is rising, but slowly. African-Americans accounted for 23 percent of the officers working in state
prisons in 2000 and 26 percent of officers employed in jails in 1999. Latinos
comprised eight percent of the officer corps in both prisons and jails. By
comparison, the proportion of African-Americans and Latinos among the
prisoner population is twice as large (BJS 2000 Census data set, Stephan
2001). For reasons of safety and for other reasons, the Commission heard
about the importance of developing a workforce drawn from the same
communities as so many of the incarcerated people—primarily poor and
urban Latino and African-American neighborhoods. Especially in nonurban areas, where racial and ethnic minority groups are underrepresented,
it is important for white officers to regularly interact with ethnic and racial
minorities as colleagues rather than solely as prisoners.
The proportion of women officers is also growing—another sign of an
increasingly diverse workforce. The greater number of women officers provides an opportunity to address the dangers and benefits that arise when
officers interact daily with prisoners of a different gender. The risks associated with male officers supervising women prisoners are well understood,
if not always protected against, but the risks posed when women hold the
position of authority, and the benefits of cross-gender supervision generally,
deserve greater attention.
America’s correctional facilities cannot operate safely and effectively
without a qualified, stable, and diverse corps of officers. State and local
governments must improve pay and find other ways, such as certification
and decertification, to enhance the profession. For the sake of everyone—

officers, prisoners, and the communities to which they return—these
reforms must begin now.

3

Support today’s leaders and cultivate the next generation.
 overnors and local executives must hire the most qualified
G
leaders and support them politically and professionally, and
corrections administrators must, in turn, use their positions to
promote healthy and safe prisons and jails. Equally important, we
must develop the skills and capacities of middle-level managers,
who play a large role in running safe facilities and are poised to
become the next generation of senior leaders.
“The fish can rot from the top,” Massachusetts corrections Commissioner Kathleen Dennehy warned the Commission, speaking of the dangers of an inattention to corrections leadership. Rhode Island’s corrections
Director A.T. Wall put it in a positive light: “As corrections leaders we
have the duty and the opportunity to shape the culture of our agencies and
institutions. If we do not want the culture to default into one of hostility, conflict, and unprofessionalism, we must work tirelessly to promote a
positive alternative.” Countless others who testified, from former prisoners
to directors to line officers, made clear that “values-driven” leadership, as
Wall put it, must extend throughout the ranks—from the director’s office
to facility wardens to shift commanders.
This common-sense mandate is hard to fulfill, however, when the average tenure for a top corrections administrator in a state system is just
three years. “Time is not on our side,” Maryland’s deputy secretary for
operations, Mary Livers, told the Commission. According to a survey of
prison and jail executives in 2003 by the National Institute of Corrections,
29 percent of respondents had held their current leadership position for
one year or less (Clem 2003).
Rapid turnover of senior administrators destabilizes the entire system,
sidelining reform initiatives as new leaders become acclimated. “It takes
the first year to understand where you are and what’s really going on,
because invariably what the governor’s office tells you and what is really
going on are two different things,” President of the American Correctional
Association Gwendolyn Chunn told the Commission. Not only must
newly minted corrections leaders learn an unfamiliar system, middle- and
upper-level managers must become accustomed to a new leader. Gary
Johnson, former executive director of the Texas Department of Criminal
Justice, explained: “[It] takes a long time to change, to make that shift. It is
a mistake for people to believe you put out a memo and change the culture.
It doesn’t work that way. It takes a lot of small steps, a lot of leadership for a
sustained period of time for people to change the way they see the world.”
The individuals who appoint corrections administrators, from governors
to county boards, must hire people for their professional qualifications—
political cronyism demeans the entire profession and puts lives at risk­—and
they must support them. That support includes listening to their expertise,
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“Staffing a prison
when funding is low,
housing prisoners when
populations are high, and
promoting progressive
change when cynicism
abounds makes the job
almost impossible.”
Mary Stohr, professor of criminal
justice and former Washington State
corrections officer

74     l a b o r a n d l e a d e r s h i p

fighting for their priorities in legislative battles, educating the public about
the issues facing corrections and the consequences for the public. We must
promote stable and excellent leadership at the top because, as Chunn put it
quite succinctly, “Time in office, I believe, is a correlate with success.”
Corrections leaders also have responsibilities they could better fulfill.
They must have the courage to confront executive and legislative leaders
when proposed policies and budgets threaten the health and safety of our
prisons and jails, and of our communities. Individually and through their
professional associations—the American Correctional Association, the
American Jail Association, the Association of State Correctional Administrators, and others—leaders in corrections can become a more powerful
force than they are today for better conditions of confinement and more
effective institutions.
When it comes to matters of safety and abuse, executive branch officials
must stand up to organized labor. The collective bargaining rights of corrections officers are extraordinarily important for officers individually and
for the development of the profession, but there must be limits when it
comes to the safety of prisoners and staff and the prevention of abuse. “As
administrators,” former superintendent Elaine Lord explained, “we cannot
be stripped of our ability to manage and protect inmates by unions. Prisons
are not places where we can have unionized staff that own posts.” Senior
corrections administrators must ensure that wardens retain the authority to
protect prisoners when there is credible evidence of abuse by staff, and then
guarantee that wardens use their authority fairly.
“Staffing a prison when funding is low, housing prisoners when populations are high, and promoting progressive change when cynicism abounds
makes the job almost impossible,” Mary Stohr, a professor of criminal
justice and former Washington State corrections officer, wrote to the Commission. These and other challenges require innovative solutions. But even
the most talented administrators cannot be expected to produce innovations on their own. Recognizing the importance of good leadership, professional organizations and some corrections departments have developed
programs to enhance the knowledge and skills of corrections leaders and
their capacity to create change. The National Institute of Corrections
(NIC), for example, offers a 70-hour Correctional Leadership Development program, and the American Jail Association is developing a national
leadership academy to provide advanced training to jail managers.
Still in short supply, however, are forums where corrections leaders can
join with each other and with a range of other stakeholders to focus on the
most vexing problems facing their institutions. Corrections leaders would
be the core participants of such forums, but experts with a view of practices
nationwide and a command of the best research on what works also would
be valuable participants in such discussions, as would advocates working
on behalf of prisoners. This effort at creative problem solving should also
involve labor leaders, when appropriate. A forum for discussion that encourages and respects each group’s diverse perspectives would help labor leaders

and corrections administrators discover common ground. Such a forum
might be modeled on the Mayors’ Institute on City Design and might be
coordinated through an existing and respected body such as NIC. Congress
should consider providing the seed money to develop such a forum.
While providing better support to today’s senior administrators, we
must also cultivate leadership at the middle levels, from captains to wardens. Middle-level managers of any facility have considerable influence.
In their role as supervisors and mentors, they have opportunities every day
to motivate and educate junior staff and, thereby, to make a real impact
on the institutional culture. They need access to the best information and
instruction available—something that many correctional systems cannot
provide internally.
To augment local training, NIC offers courses for a small number of
managers each year. Its Management Development for the Future series—a combined classroom and on-site program—focuses specifically
on corrections managers at the middle levels who might go on to become
senior administrators. This program and a number of other NIC training
efforts aim to convey new developments in the field and addresses important issues raised by changing circumstances in the correctional landscape.
These are valuable learning opportunities for managers and leaders-to-be,
but NIC’s programs are not reaching enough people.
Congress should allocate funds for NIC to train 1,000 middle-level
managers each year. Such a commitment to the highest quality training
for these influential staff will help to ensure that the best practices and
knowledge are disseminated across the nation. Equally important, advanced training for middle-level managers would provide a way to identify,
groom, and motivate the next generation of senior corrections administrators—the leaders necessary to keep improving the safety and effectiveness
of America’s prisons and jails.

New to the Job
According to a 2003 survey, 29 percent or nearly
one out of every three corrections agency
executives had occupied their current leadership
position for one year or less.

source: national institute of corrections, 2003

labor and leadership: recommendations recap
1.	 Promote a culture of mutual respect. Create a positive culture in jails and prisons
grounded in an ethic of respectful behavior and interpersonal communication that
benefits prisoners and staff.
2.	 Recruit and retain a qualified corps of officers. Enact changes at the state and
local levels to advance the recruitment and retention of a high quality, diverse
workforce and otherwise further the professionalism of the workforce.
3.	 Support today’s leaders and cultivate the next generation. Governors and local
executives must hire the most qualified leaders and support them politically and
professionally, and corrections administrators must, in turn, use their positions to
promote healthy and safe prisons and jails. Equally important, we must develop
the skills and capacities of middle-level managers, who play a large role in running
safe facilities and are poised to become the next generation of senior leaders.

c h a n g e t h e c u lt u r e a n d e n h a n c e t h e p r o f e s s i o n

75

What prisons and jails need is
“light, light, and more light.”
Margaret Winter, associate director,
National Prison Project of the
American Civil Liberties Union

III. Oversight and
	 Accountability
every public institution—hospitals, schools,

police departments, and prisons and jails—needs and
benefits from strong oversight. Perhaps more than
other institutions, correctional facilities require
vigorous scrutiny: They are uniquely powerful
institutions, depriving millions of people each
year of liberty and taking responsibility for their
security, yet are walled off from the public. They
mainly confine the most powerless groups in

The majority of
officers “did the work
as required by rules
and regulations, but
often with the
exception of not
reporting certain
incidents observed
for fear of job loss
or retaliation.”
Ron McAndrew, former
prison warden in Florida

America—poor people who are disproportionately
African-American and Latino. And the relative
safety and success of these institutions have broad
implications for the health and safety of the
public. Throughout the Commission’s hearings,
in discussions of virtually every substantive
area of concern, witnesses expressed the critical
importance of oversight and accountability, both
from within the profession and from without.
ov e r s i g h t a n d a c c o u n ta b i l i t y

77

Margaret Winter, associate director of the National Prison Project of the
American Civil Liberties Union said that what prisons and jails need is
“light, light, and more light.” Rhode Island’s corrections Director A.T. Wall
stressed to the Commission the importance of monitoring from within:
“Recognizing that our correctional institutions—like all other institutions
in which the exercise of power is a defining characteristic—have the potential for abuse, we cannot sit idly by. If we do so, we run the substantial
risk that the dynamics of these environments will default to a position
where misconduct can ultimately flourish.” Winter added that oversight
must take multiple forms, from the “power of courageous news reporting”
to action by federal judges who with lifetime tenure can “take the heat,”
from social scientists doing research to good corrections directors, wardens, officers, and other staff engaged in monitoring their own systems.
Oversight and accountability encompass several distinct but related activities. Some of them, such as independent inspection, litigation and court
oversight, and direct inquiry from the public and the press, rely on the work
of outsiders. Other activities, such as auditing, professional accreditation,
and internal investigations of alleged wrongdoing must be conducted from
within the profession. The key, many people told the Commission, is never
to rely on any single mechanism of oversight and accountability, but rather
to take what Professor Michele Deitch calls a “layered approach.” The different activities must be mutually supportive, pointing to the same goals
and being comprehensive without being redundant or overly burdensome.
Together, the efforts of both insiders and outsiders can ensure that prisons
and jails are open and responsive to public scrutiny and that they evolve in
ways that make them safer, more effective institutions. That is the promise
of oversight, but it remains far from fully realized in the United States.
Oversight of America’s prisons and jails is underdeveloped and uneven. The foundation exists, however, to improve the mechanisms that
now exist and to create new ones. In this section, the Commission addresses how to strengthen and expand external monitoring of correctional systems and how to improve oversight and accountability within
the corrections profession. We also recommend ways in which prisons
and jails can become more transparent to and understood by the public.

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Invest in External Oversight

jack cowley, former warden with more than 20 years of 
experience in the Oklahoma prison system, was one of many witnesses
to stress to the Commission the need for external oversight to bolster the
ways corrections professionals hold themselves and their staffs accountable.
“When we’re not held accountable,” Cowley said, “the culture inside the
prisons becomes a place that is so foreign to the culture of the real world
that we develop our own way of doing things.” Just as the public does not
rely solely on self-policing of public hospitals, it should not do so with correctional agencies. Yet, some corrections administrators have been resistant
to external monitoring, and by and large the public and its representatives
have not insisted on it.
For there to be any sustained response to the issues of safety and abuse
raised in this report, there must be strong independent oversight of prisons
and jails nationwide. External oversight, particularly sustained intervention
by the federal courts, provided much of the impetus for raising prison and
jail conditions from their truly deplorable state three or four decades ago.
The Commission urges state and federal legislators, with the collaboration of corrections leaders, to enhance and expand external oversight in
four ways: develop independent government inspection and monitoring
systems, create a national non-governmental organization to visit and
inspect prisons and jails, expand the capacity of government investigators,
and ensure access to the judicial process for prisoners who are victims of
constitutional violations.

recommendations
1.	 Demand independent oversight.
2.	 Build national non-governmental
oversight.
3.	 Reinvigorate investigation and
enforcement.
4.	 Increase access to the courts by
reforming the PLRA.

1

Demand independent oversight. Every state should create an
independent agency to monitor prisons and jails.
Perhaps the least developed form of oversight at present is independent
inspection and monitoring. Few states have monitoring systems that operate outside state and local departments of corrections, and the few systems
that do exist are generally underresourced and lacking in real power.
Former Florida Warden Ron McAndrew told the Commission that for
many years he had sought “a key that would open the door to better and
safer security” and hoped for an independent “legal observer” who would
monitor each prison and have unlimited access to the facility, its records,
and its staff and prisoners. The federal government follows this model with
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79

an Inspector General’s office operating outside of the Federal Bureau of
Prisons. Its director, Department of Justice Inspector General Glenn Fine,
urged the wider use of this model. Despite the relative rarity of independent
monitoring as a central component of correctional oversight in the United
States, there are examples approaching McAndrew’s long-sought key.
Perhaps the most comprehensive is California’s Office of the Inspector
General (OIG), significantly revamped in 2004. The Inspector General
is fully independent from the corrections department and even insulated
from the governor (by virtue of a six-year term and protection from termination absent good cause) and to some extent the legislature (by virtue of a
budget based on caseload—currently $15.3 million annually). And it has the
authority—a “golden key” as Inspector General
Independent Oversight in Great Britain
Matthew Cate told the Commission—to visit
Her Majesty’s Inspectorate of Prisons has a mandate to examine and report on
and inspect any facility within the state prison
conditions in each of the 139 prisons and jails in England and Wales. This wellsystem at any time, without notice. It has a staff
regarded independent monitoring system relies on the power of persuasion
of 95 to implement that authority. The OIG has
and collaboration. Rigorous and typically unannounced inspections are offered
two core functions: First, it carries out top-toas a “free consultancy, trying to improve performance,” as described by Chief
bottom performance evaluations and investigates
Inspector of Prisons Anne Owers. And although it has no authority to force
alleged wrongdoing of managers; second, it prochange, this collaborative approach is bolstered by a policy to encourage action
vides real-time oversight of the corrections dethrough publication of its reports. The enabling statute goes one step further:
partment’s internal affairs investigations of staff
It requires prison managers to file a response stating whether they accept the
misconduct. The lack of transparency in Califorrecommendations in the report. Most often they do.
nia corrections led to the creation of the OIG,
In her testimony to the Commission, Owers described the benefits of her
and transparency is now infused into the OIG’s
work: “We can look at what’s actually happening on the ground. . . . Even in wellwork by statute. Every facility audit and sumrun prisons I don’t think I have ever been on an inspection which hasn’t found
maries of all investigations must be provided to
something, however small, that the governor or the warden of the prison didn’t
the legislature and to the public. The OIG has no
know was happening and where the warden hasn’t said, ‘I’m glad you told us that,
enforcement power but relies on the persuasive
I will need to take account of that,’ and that is a very important, preventive role
power of publishing its findings and the power of
that inspection can play. . . . I think independent inspection which is coming from
collaboration, both with corrections leaders and
outside the institution can provide a credible voice which gives some political
non-governmental groups of interest.
space for reforming and changing prisons.”
Other models exist for independent moniThe monitoring aims to achieve four “expectations”: safety, even for the most
toring. States and localities have corrections
vulnerable prisoners; respect for the human dignity of all prisoners, purposeful
boards or commissions which can play an inactivity available to all prisoners and for their benefit; and resettlement, which
spection and monitoring role. Ohio has created
means preparing people for release in a way that reduces the likelihood of
a legislative body that inspects that state’s prisreoffending (Her Majesty’s Inspectorate of Prisons 2004).
ons. The Ohio Correctional Institution InspecThe work of the Inspectorate is echoed by a similar function performed in 46
tion Committee, composed of eight legislators,
European countries by the Council of Europe’s Committee for the Prevention of
inspects every prison in the state at least every
Torture and Inhuman or Degrading Treatment or Punishment. Its president, Silvia
two years. Among its obligations, the CommitCasale, told the Commission: “In Europe, oversight mechanisms have gradually
tee is required by state law to review prisoner
developed, at the international, the national, and the local level. Mistakes have
grievance procedures in each facility and report
been made along the way, but workable systems are emerging. Perhaps these
its findings annually to the full legislature. One
developments can inform the debate in the United States on safety and abuse
example of a monitoring body often cited for its
in custody, on the theory that one can learn from other people’s errors as well as
role in collaboratively improving practice is the
from their successes.”
Florida Correctional Medical Authority. Created
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as a means to replace more than 20 years of federal court intervention in
Florida’s prison medical care system, the CMA works in collaboration with
both the corrections and health departments. Although it receives administrative support from the latter, it remains independent from both.
Reflecting on the limits of litigation and the need for a better prophylactic approach, U.S. District Judge Myron Thompson told the Commission to look to the executive and legislative branches of government:
“Only they can step in beforehand and actually prevent constitutional
violations.” The Commission strongly urges states to create a monitoring
body independent of the department of corrections which might draw
on California’s OIG or one of the other state or local models. It must be
sufficiently empowered and funded to inspect and report on conditions
and practices in every jail and prison statewide and be dedicated to timely,
accurate, and complete public reporting of the problems it identifies.
Crucial to its success is a staff that is knowledgeable about correctional
systems and sensitive to the challenges managers and staff face. While
not a tool of management, through cooperation and collaboration with
corrections administrators, this external monitoring body can become essential to management. Typically, an independent monitor has no formal
enforcement authority and relies instead on its credibility and powers of
persuasion. Yet, the corrections department should be required to formally and publicly respond to its findings and to document compliance,
or noncompliance, with its recommendations.

2

Build national non-governmental oversight. Create a national
non-governmental organization capable of inspecting prisons
and jails at the invitation of corrections administrators.
There are times when correctional agencies would benefit from the ability to request confidential monitoring and assistance from a neutral party,
especially to investigate and resolve distinct problems. What is needed is a
new, national non-governmental organization that is committed to working with corrections leaders outside of advocacy and litigation channels,
bringing a fresh eye and credible voice to new and old problems. The work
of such a group would not be subject to public review, would not result
in externally published reports, and would not be available in litigation
involving facilities that invite its assistance.
This new non-governmental organization would operate within parameters developed in consultation with the corrections administrators who
seek its help. These would set forth the scope of the review, the powers
granted to the reviewers, and the form of the end report. At the very least,
the organization would be authorized to visit facilities, privately interview
prisoners and staff, and review internal documents. Ensuring ongoing
confidentiality through protection from discovery in litigation would require creating an attorney/client or similar relationship, depending in part
on state law. The organization would produce a report for the internal use
of corrections and other state government officials and make pragmatic

“When we’re not held
accountable, the culture
inside the prisons
becomes a place that is
so foreign to the culture
of the real world that we
develop our own way of
doing things.”
Jack Cowley, former prison warden
in Oklahoma

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81

“There is tremendous
pressure within an
institution to keep quiet.”
Glenn Fine, U.S. Department of Justice
Inspector General

recommendations for addressing the problems identified. The organization
would draw on a pool of investigators experienced in corrections who understand and support the organization’s mission and approach and who are
trusted by corrections staff and prisoners. Development of such an organization should be undertaken in consultation with the National Institute
of Corrections, and perhaps other national bodies that are knowledgeable
about and sensitive to the needs of corrections managers.
The virtue of such an approach—relying on invitation, a limited and focused review, and confidentiality—is that administrators need not fear asking tough questions about the performance of their systems and can benefit
from the impartial views of people who bring a national perspective to the
task and are not invested in the current policies and practices. This kind of
voluntary and confidential problem-solving review would also help administrators prepare for review of their systems by independent government
monitors who have an obligation to report findings to the public. And they
could use select findings from a confidential review to build support for
their reform agenda, demonstrate a need for more resources, and document
a baseline against which future achievement can be measured.
The inspiration for this form of confidential oversight is the International Committee of the Red Cross (ICRC), which carries out inspections of detention facilities in conflict zones worldwide. The ICRC is
formed on the belief that “detention problems are best solved through
constructive dialogue based on mutual confidence, rather than in the
glare of publicity which inevitably carries the risk of politicizing the
issues” (ICRC 2004). The creation of a national organization capable of
serving in a similar capacity would benefit all concerned: Corrections
administrators, staff, and prisoners would have the benefit of consulting
with a neutral party. And managers in particular could rely on a fair and
objective assessment of their work, one that recognizes their strengths
and provides constructive advice for improvement grounded in the reality
of their particular systems and facilities.

3

Reinvigorate investigation and enforcement.  Expand the
investigation and enforcement activities of the U.S. Department
of Justice and build similar capacity in the states.
“There is tremendous pressure within an institution to keep quiet,” Glenn
Fine, inspector general of the U.S. Department of Justice, told the Commission. He explained that this makes it all the more important to have
strong governmental oversight of prisons and jails. At present, the only
federal entity that investigates state and local correctional facilities across
the country is the Department of Justice. DOJ can initiate investigations
and bring criminal prosecutions and civil actions when it sees incidents or
conditions that violate federal statutes or prisoners’ constitutional rights.
The reach of these powers, however, has always been limited. In recent years,
their use has become increasingly sparse. We must expand the capacity of
DOJ in this area and build similar capacities in the states.

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Criminal investigation and prosecution is an important component of
correctional oversight. William Yeomans, former deputy assistant attorney
general at the Civil Rights Division of the Department of Justice, told
the Commission: “The violence inflicted on inmates frequently results
in bodily injury and establishes a tone in an institution that force is an
acceptable means of addressing problems in an institution. Prosecutions
that punish the offenders in these situations emphasize that all members
of the corrections community must abide by the law.” Criminal enforcement at the federal level is crucial because too frequently local jurisdictions lack the political will, and sometimes the expertise, to thoroughly

Criminal enforcement at the federal level is crucial because too
frequently local jurisdictions lack the political will, and sometimes
the expertise, to thoroughly investigate and prosecute abusive
corrections officers within their own communities.
investigate and prosecute abusive corrections officers within their own
communities. But even in the best of circumstances, when local prosecutors support federal investigations and prosecutions, a limited number
of criminal cases can have only a limited impact. In Yeomans’ words,
“Broader issues regarding the safety of the prison, the training of officers,
the adequacy of administrative processes and overall conditions in the
prison [often] go unaddressed.”
The 1980 Civil Rights of Institutionalized Persons Act (CRIPA) gives
DOJ, through its Special Litigation Section, authority to initiate civil
lawsuits to remedy egregious conditions in prisons and jails. These civil
actions have the power to bring greater systemic change than criminal
prosecutions because they can result in court-enforceable consent decrees
that mandate and guide specific reforms. During the course of an investigation, Section attorneys, along with experienced corrections consultants,
gain access to a correctional facility and talk to both staff and prisoners.
The result, according to Yeomans, are “‘findings letters’ that reflect the
detailed findings and recommendations of experts who have toured the
facility and examined its practices [and that] can serve as a blueprint for
a willing institution to improve itself.” Civil actions, which should begin
with a collaborative problem-solving approach, can have positive effects
even if they are settled before formal litigation is initiated.
In recent years, DOJ’s output has been low on both the criminal and
civil sides. The Criminal Section has been given broader responsibilities without the resources to fulfill them adequately and has focused on
prosecuting human trafficking and involuntary servitude cases. On the
civil side, the Special Litigation Section has been investigating only a
very small number of correctional systems and appears less insistent that
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Diminished Oversight
Through Litigation
civil rights investigations
by the department of justice,
special litigation section,
from 1996 to 2004 *
Investigations declined:

11 investigations
in 1996
2 investigations
in 2001 and in 2004

Fewer lawsuits were filed:

7 lawsuits in 1997 and in 1999
zero lawsuits in 2003
*Adult prisons and jails only

source: u.s. department of justice

lawsuits by prisoners,
before and after the plra
(prison litigation reform act )

Civil rights cases declined
by nearly half:
In 1995, one year before the plra

37 cases filed...
per 1,000 prisoners

Five years later, in 2000

19 cases filed
per 1,000 prisoners

Plaintiffs were less successful:
In 1995, one year before the plra

13% success...

Six years later, in 2001

10% success
sources: administrative office of the u.s. courts,
bureau of justice statistics

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troubled systems enter into court-enforceable consent decrees. In fiscal
years 2003 and 2004 combined, the Section initiated six investigations and
filed only one civil court action addressing conditions in adult prisons or
jails (USDOJ).
The Department of Justice has the powers it needs to effectively investigate civil rights violations in correctional facilities; it must be given the
resources and the mandate to vigorously employ them. As a first step, Congress should hold hearings to examine the reasons for the small number
of cases filed by the Special Litigation Section and the challenges facing
DOJ in investigating and prosecuting criminal behavior within correctional facilities.
Equally important, states should become more involved in investigating and prosecuting criminal misconduct by prison and jail staff and
civil rights violations caused by facility practices or conditions. After
all, state prisons and local jails make up the vast majority of America’s
correctional facilities. As mentioned previously, this is not a job that
most local prosecutors’ offices are prepared to handle. Resources in these
offices are stretched thin, and local prosecutors may not be in the best
position to handle these types of cases. They may have little experience
with the challenges of collecting evidence in a culture often ruled by a
code of silence, or with the differences between prosecuting law enforcement officers rather than “common criminals,” or with overcoming the
higher burden of proof that juries tend to require in cases where the
victim is a prisoner. For these cases, states need a capacity much like
DOJ’s Civil Rights Division, Criminal Section. State attorneys general
or other statewide law enforcement agencies should be empowered to
partner with local prosecutors to investigate civil rights violations in
correctional facilities and prosecute them when warranted. They should
also be granted the power to review local investigations and to prosecute
cases that a local prosecutor has declined, either because of a lack of will
or a lack of resources or expertise.
Both the federal government and the states must lead vigorous efforts to
investigate and bring civil or criminal actions against correctional agencies
and individual officers for unlawful conditions and behavior.

4

Increase access to the courts by reforming the PLRA. Congress
should narrow the scope of the Prison Litigation Reform Act.
For some time now, the federal courts have played the biggest role in
watching over America’s prisons and jails and shedding light on the most
dangerous conditions and abuses. According to scholars Malcolm Feeley
and Van Swearingen, “Litigation has probably been the single most important source of change in prisons and jails in the past forty years” (Feeley and
Swearingen 2004). With their independence from political forces and their
obligation to protect the rights of those whose pleas might otherwise go unheard, federal judges provide the oversight of last resort, and in some cases
the only truly effective monitoring. It is a role that must be protected.

Litigation became the default form of oversight in part because corrections leaders understood it could play a constructive role. In fact, litigation is often welcomed—occasionally invited—by system administrators
who themselves are desperate for help that they are not receiving from
lawmakers. Criminology professor and researcher Barbara Owen told
the Commission that prison administrators have said to her, “Why don’t
you call up some of your friends and have them sue me?” James Gondles,
executive director of the American Correctional Association, explained
what a lawsuit can trigger: “State legislatures or county commissioners
have responded to those suits by increasing budgets and improving programs, which has also had a rippling effect of improved programs and
funding for other correctional facilities and agencies, without another
lawsuit being filed.”
Nonetheless, many have pushed back against prisoners’ federal civil
rights litigation. Over the last decade, this important source of oversight
has declined, principally as a result of the 1996 Prison Litigation Reform
Act (PLRA). The law was passed to eliminate what was described as a
flood of frivolous prisoner lawsuits. Although there were a large number
of lawsuits, Congress conducted no studies and held only one substantive
Malcolm Feeley and Van Swearingen
hearing to consider potential solutions before passing the PLRA as a rider
to an appropriations bill. The resulting legislation has caused so much
confusion and provoked so much litigation about its own meaning that
one federal Court of Appeals noted, “When Congress penned the Prison
Litigation Reform Act . . . the watchdog must have been dead” (McGore v.
Wrigglesworth 1997).
The Supreme Court has described the PLRA’s purposes, in part, as
twofold: “to reduce the quantity and improve the quality of prisoner suits”
(Porter v. Nussle 2002). Since its enactment, prisoner lawsuits in federal court are dramatically
Prisoner Civil Rights Cases: Frivolous or Not?
down, by nearly half when the increase in the
At the time the PLRA was enacted, prisoners were annually filing almost 41,000
prison population is taken into account. The
civil rights actions in federal court, although prisoners were no more litigious than
year before the law took effect, the rate of filing
other Americans when both state and federal filings are counted (Administrative
was 37 civil rights actions per 1,000 prisoners;
Office of the U.S. Courts, Schlanger 2003). In fact, the debate over the PLRA
five years later it was 19 per 1,000 (Scalia 2002).
conflated “frivolous” with “non-meritorious” cases. Although only 15 percent
While the total number of cases is down, there
of prisoners’ civil rights suits prevailed in the early 1990s, only a very small 4.8
is no reason to believe that the PLRA actually
percent were dismissed as legally or factually frivolous (Fradella 1998). There
filters out frivolous claims. If success in litigation
are many reasons that prisoners’ suits have a low success rate. One is the high
is a measure of case quality, the PLRA has failed:
threshold courts have established for proving a constitutional violation. In the
The proportion of successful suits went down
prison medical care context, for example, where the courts have confirmed an
after its enactment (Schlanger 2003). Something
Eighth Amendment right to medical treatment, prisoners can prevail in court only
else happened. Between 1995 and 2000, court
if they can prove that the failure to provide necessary care was the result of a
monitoring of prisons diminished. The number
particular defendant’s “deliberate indifference” to their serious medical needs.
of states with little or no court-ordered regulaThis difficult standard led one federal judge to plead for change: “As the law
tion of their prisons (those having no more than
stands today, the standards permit inhumane treatment of inmates. In this court’s
10 percent of prisoners living in a facility under
opinion, inhumane treatment should be found to be unconstitutional treatment”
court supervision) more than doubled, from 12
(Ruiz v. Johnson 1999).

“Litigation has

probably been the single

most important source

of change in prisons
and jails in the past
forty years.”

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85

states to 28 (BJS 1998, BJS 2004). The Commission urges Congress to
amend the PLRA in the following four ways.
First, eliminate the physical injury requirement. The PLRA bars a federal
civil rights action by a prisoner “for mental or emotional injury suffered
while in custody without a prior showing of physical injury” (42 U.S.C.
§1997e(e)). In the words of Stephen Hanlon, a lawyer experienced in classaction prisoner litigation, this provision “seems to make it national policy the idea that mental torture is not actionable.” Many serious abuses
leave no physical injury. For example, sexual assault in prison is likely to be

Congress conducted no studies and held only one substantive
hearing to consider potential solutions before passing the PLRA as
a rider to an appropriations bill.
coerced rather than forcible and thus often results in no physical injury. The
courthouse door should not be barred to anyone that a corrections system
fails to protect from sexual assault.
Second, eliminate the filing fee for indigent prisoners or make it reflective of the person’s earning power, and ­ eliminate the restrictions on
attorney fees. The PLRA discourages prisoners from filing lawsuits, and
attorneys from representing them, through a range of economic burdens
and disincentives. Under the PLRA even indigent prisoners must pay a
filing fee of $350, which is collected over time from their accounts, presenting an insurmountable burden for many prisoners (28 U.S.C. §§1914 and
1915(b)). Court filing fees are normally waived for indigent plaintiffs. Just
as problematic, the PLRA discourages attorneys from representing prisoners with civil rights claims by capping their fees at an unrealistic level (42
U.S.C. §1997e(d)(3)). And if the prisoner prevails in court, the attorney’s
fees are limited to a percentage of the damages awarded to a prisoner,
which are considerably lower than in other civil lawsuits, rather than being
calculated on an hourly basis as in other types of federal litigation (42
U.S.C. §1997e(d)(2)). These provisions are counter-productive because they
discourage representation even in meritorious cases.
Third, lift the requirement that correctional agencies concede liability as
a prerequisite to court-supervised settlement. The PLRA bars a court from
approving a consent decree—a form of settlement—without determining
that a constitutional violation has occurred, and the court cannot make that
determination prior to trial unless the defendant concedes liability (18 U.S.C.
§§3626(c)(1) and (a)(1)(A)). This is a major obstacle to settling cases because
a central purpose and attraction of negotiated settlements is that the question of liability need not be resolved. Although the statute allows for private
settlement agreements when there is no such concession, the implementation of the terms of these settlement agreements cannot be monitored by a
federal court, undercutting the court’s critical oversight function.
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Fourth, change the “exhaustion” rule. The PLRA bars the courthouse
door to prisoners who have not fully “exhausted” all available grievance
procedures in the facility where they are incarcerated (42 U.S.C. §1997e(a)).
Prior to the PLRA, the Civil Rights of Institutionalized Persons Act
(CRIPA) required that the application of an “exhaustion rule” hinged on
the existence of a grievance procedure that met standards set by the Department of Justice (28 C.F.R. §§40.1-40.22). The standards are important
because if the grievance procedures are meaningless or unnecessarily cumbersome or strict, an exhaustion rule simply undermines access to justice.
At the time this report went to press, the Supreme Court was set to
decide a related matter: whether the PLRA’s exhaustion rule also bars
judicial review when a prisoner fails to meet a filing deadline or other
procedural requirement. Many states and localities require prisoners to file
a grievance in as little time as within three days of an incident (Woodford v.
Ngo brief 2006). If the Court rules there is a “procedural default” element
in the PLRA exhaustion rule, a prisoner claiming that a facility failed to
protect him from assault might be forever barred from a legal remedy if
he were locked in a segregation unit or held in a medical unit for three
days without access to the grievance process. Congress should encourage
reliance on meaningful grievance procedures—and meaningful procedural
justice—by returning to the CRIPA exhaustion rule, and if the Court
identifies a procedural default element in the exhaustion rule, Congress
should eliminate it.
These four changes to the PLRA would increase the ability of federal
courts to both deliver justice to individual prisoners and to provide the
authority necessary to force reform of facilities where people are in danger
or subject to abuse.

invest in external oversight: recommendations recap
1.	 Demand independent oversight. Every state should create an independent agency
to monitor prisons and jails.
2.	 Build national non-governmental oversight. Create a national non-governmental
organization capable of inspecting prisons and jails at the invitation of corrections
administrators.
3.	 Reinvigorate investigation and enforcement. Expand the investigation and
enforcement activities of the U.S. Department of Justice and build similar capacity
in the states.
4.	 Increase access to the courts by reforming the PLRA. Congress should narrow the
scope of the Prison Litigation Reform Act.

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87

Strengthen Accountability
Within the Profession

recommendations
1.	 Monitor practice not just policy.
2.	 Strengthen professional standards.
3.	 Develop meaningful internal
complaint systems.

the corrections profe ssion in america has a strong 
commitment to meeting the increasing challenges it faces, demonstrated
in part by the considerable progress of corrections administrators in building systems to monitor their work and to promote accountability from
within. That internal accountability takes several forms: from internal affairs bureaus and correctional inspectors general to internal auditing and
performance measurements and evaluations. These efforts are all the more
impressive given that they have been largely self-generated rather than
imposed through political pressure. However, the Commission agrees
with the many corrections leaders who told us that there is still much
left to accomplish in the realm of internal accountability and oversight to
transform a relatively closed and unregulated domain within state and local
governments to an open one. This chapter explores two areas that invite
improvement: professional accreditation and internal systems for reporting
unsafe or abusive conditions.

1

Monitor practice not just policy.  Ensure that American
Correctional Association accreditation more accurately reflects
practice as well as policy.
Since the mid-1970s, the American Correctional Association (ACA), the
principal corrections professional association, has offered an accreditation
program for prisons and jails. This voluntary and rigorous process involves
auditing facilities for compliance with ACA’s standards covering virtually
every aspect of correctional operations. It is essentially a collaborative effort
by individual corrections managers and the ACA to raise the level of professionalism in a particular facility or systemwide. The Commission heard
repeatedly that ACA accreditation is an important indicator of safety and
humane treatment in a prison or jail. Accreditation has limits, which is why it
must complement rather than substitute for other, more independent forms
of oversight. But there is little doubt that it is a spur to good practice.
At present, 525 of the nation’s 1,208 adult prisons and a strikingly low
120 of the 3,365 jails across the country are ACA accredited. The Commission urges many more facilities to seek accreditation and, at the same time,
urges the ACA to strengthen the process so that accreditation is even more
meaningful. The primary concern about the accreditation process is that it

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focuses too heavily on a facility’s written policies and procedures without
sufficient corroboration from direct observation. The result, critics contend,
is a certification process that does not do justice to the ACA standards and
does not sufficiently indicate to managers, legislators, and the public how
well—or poorly—an institution functions from day to day.
The accreditation process is extensive, including review of a prior selfevaluation by the facility’s own managers, review of documentation regarding compliance with standards, a three-day compliance audit by three
corrections professionals followed by a hearing, and consultation throughout the process (ACA 2003). To be accredited by the ACA, a facility must
meet or exceed all of the mandatory standards—roughly 10 percent of the
standards are mandatory—and meet 90 percent of the remaining, nonmandatory standards. Accreditation extends for three years, and facilities
must annually certify their continued compliance with the standards. As
extensive as the audit process is, no single audit or series of audits spaced
years apart can determine whether policies and practices are routinely
carried out. As former Warden James Bruton put it in his Commission
testimony, “I’m a big believer in it [ACA accreditation], but . . . the only way
it has teeth is if the warden of the institution is inside every day being sure
those standards are being followed.”
Inherent limitations aside, there are a number of ways that the ACA
could improve its ability to gauge practical compliance over time. One way
would be to institute one or more mid-term inspections, whereby a team of
auditors would come in—perhaps unannounced—to check on compliance
in a limited number of areas. Undoubtedly, a series of unannounced visits
would contribute to the accreditors’ ability to evaluate practical compliance
and could help administrators identify trouble spots. There is no reason
why unannounced visits cannot be part of a collaborative relationship between facility administrators and accreditors, and collaboration need not
preclude an objective review geared to improving operations.
Another innovation would be to institute a procedure whereby staff and
prisoners can report deficiencies in practice to the ACA audit committee.

Accreditation has limits,
which is why it must
complement rather than
substitute for other, more
independent forms of
oversight. But there is
little doubt that it is a
spur to good practice.

Professional Accreditation Remains Underused
prisons

57%

jails

43%

525, or 43 percent, of the nation’s
1,208 adult prisons are accredited by
the American Correctional Association

96%

4%

Only 120, or 4 percent, of the nation’s
3,365 jails are accredited by the
American Correctional Association

sources: american correctional association, bureau of justice statistics

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Several witnesses told the Commission that facilities were spruced up for
visits and then reverted to disorder when the auditors left. Confidential
questionnaires before and after an audit could be used to elicit specific
information about compliance over time.
A third change would be to alter those standards that may contribute
to accreditation’s failure to reflect practical compliance. Some standards,
including some mandatory standards necessary for “life safety,” expressly
require no more than a written plan (e.g., Standards 4-4224 responding to
security threats, 4-4300 periodic classification review, 4-4357 HIV management). Consideration should be given to changing these and similar
standards to require a greater degree of compliance in practice.
The ACA has been taking steps on its own to improve the process. Over
the past five years, the ACA has begun to move towards performancebased standards and outcome measures designed to demonstrate actual
compliance with the standards. This pilot effort has been focused on standards governing health care but will be expanded to other areas.
While self-monitoring aided by a professional association can never
substitute for independent monitoring by government, the ACA’s accreditation process is an important way to raise standards and improve
practice in prisons and jails nationwide. The Commission urges the ACA
to continue to make accreditation more rigorous and objective—for the
good of all the correctional systems that already seek accreditation and for
the many more that should.

2

Strengthen professional standards.  Support and improve
American Correctional Association standards.
The more than 500 American Correctional Association (ACA) standards
form a comprehensive framework for guiding and assessing the operations of
a prison or jail (ACA 2003). They are the only standards governing the core
operations of adult correctional facilities. (Standards developed by other organizations govern particular areas of operations, most notably health care.)
The standards are developed, and revised as necessary, by a 20-member committee selected by the president of the ACA and the chairman of the commission responsible for accreditation. The Standards Committee includes
members from outside the corrections field, invites input from and consults
with a range of interested groups, and holds meetings that are open to the
public. Several witnesses told the Commission that the ACA standards are
an extremely important tool to promote safe and humane conditions in
prisons and jails but that they could be improved in two ways. First, they
could be stronger. Second, they could benefit from even more input from
individuals and organizations from outside the corrections profession.
Currently, most of the standards set a low threshold to encourage compliance. As ACA Deputy Executive Director Jeffrey Washington told the
Commission, “This whole process, one forgets, is [about] minimal standards.” The notion of minimal standards, however, is often criticized. Brian
Dawe, executive director of Corrections USA, a national organization of

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corrections labor groups, told the Commission that “in order for an accreditation process to effectively address the issues that plague corrections,
it must be fearless...raising standards whenever possible.” Standards Committee member Michael Hamden agrees that although accreditation is a
good process, some of the standards are not tough enough. “I agree there
are standards that do not come to the level I think we could accomplish,” he
said. Hamden, who as executive director of North Carolina Prisoner Legal
Services was a skeptic about the standards and accreditation process when
he joined the Committee, has become a strong proponent of the system.
The Commission learned of a number of important areas in which ACA
standards are insufficient or should be made mandatory. We offer two examples: one broadly applicable and one quite narrow.

“In order for an accreditation process to effectively address the issues
that plague corrections, it must be fearless . . . raising standards
whenever possible.”

Brian Dawe, executive director of Corrections USA

The ACA standards should require that all prisons provide substance
abuse treatment to those in need. The current standard (4-4377), which is
not mandatory, requires that prisoners have “access to” a treatment program
and requires a needs assessment, treatment plan, education, and a discharge
plan. These are all the right steps, but the standard falls short of requiring
that access to treatment translates into delivery of treatment. Perhaps as
many as 80 percent of prisoners are in need of drug or alcohol abuse treatment, and many facilities have lengthy waiting lists for an insufficient number of long-term treatment slots (Mumola 1999). Untreated dependency can
be a catalyst to violence and other behavioral problems. Moreover, the wait
for treatment often outlasts a prisoner’s sentence, threatening the prisoner’s
success on release and potentially the safety of the community to which he
or she is released. The ACA standard on substance abuse should be mandatory and should guarantee that accredited facilities are in fact providing
treatment to those in need.
The standard governing exercise time for prisoners in segregation (44270) requires only that they have opportunities to exercise outside of their
cells one hour per day, five days per week, and only when “security and
safety concerns [do not] dictate otherwise.” The standard was developed to
meet constitutional norms set by the courts and to reflect limits imposed by
staffing constraints. But minimal constitutional standards aside, five hours
per week is insufficient given the small size of segregation cells and the
other harmful strictures imposed on people in segregation.
In the process of developing stronger, more constructive standards, the
ACA Standards Committee would benefit from including an even greater
range of voices and interests than it presently does. According to Jeffrey
Washington, the Committee has made efforts in this regard—engaging
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“[There is] a recurrent
pattern in American
prisons of threats

and responding to groups that advocate for lower prisoner phone rates and
tougher standards governing prisoner sexual abuse, for example—and will
continue to seek and listen to advice from advocates and others.
The Commission encourages the ACA to involve the broadest range of
interested parties in the process of developing ever stronger standards for
correctional practice. It is particularly important to involve representatives
of organized labor—a critical source of knowledge, an important constituent, and a group that feels it has not had a voice in the development
of ACA standards. Seeking input from current and former prisoners is
equally important. And the Commission invites the Standards Committee
to use this report as a guide for strengthening those standards that have a
direct influence on the safety of prisoners and staff.

3

Develop meaningful internal complaint systems. Corrections
and retaliation against
managers should strengthen the systems that allow them to
listen to those who live and work in prisons and jails.
prisoners who
Corrections leaders at all levels have much to learn from those who live in
prisons and jails and those who work in the tiers and pods. No director, warfile grievances and
den, or shift commander alone can know all he or she needs to know. Strong
internal oversight and accountability depend on listening to the people
complaints.”
with day-to-day knowledge of conditions and acting on what they say. That
means establishing meaningful and safe grievance procedures for prisoners
John Boston, director of the Prisoners Rights
to use and also encouraging staff to report unsafe conditions and abuses.
Project of the New York City Legal Aid Society
Meaningful grievance and complaint systems for prisoners serve three
critical functions. First, they are an important source of knowledge about
the functioning of a facility. Prisoners want their facilities to be safe and
orderly and should be able to point out problems and offer potential solutions (Commonwealth of Massachusetts Governor’s Commission on
Corrections Reform 2004). Second, a meaningful grievance system demonstrates commitment to procedural justice and the rule of law. There can
be no accountability for safety failures and misconduct if victims are not
encouraged to make their grievances known. Moreover, the right to seek a
judicial remedy depends on compliance with exEarly Warning Systems
isting grievance procedures, so justice demands
Careful attention to complaints from prisoners and efforts to encourage staff to
that those procedures be meaningful and freely
report misconduct—and protection for both groups—should be coupled with the
available (see “Increase access to the courts by
development of early warning systems that identify officers prone to misconduct.
reforming the PLRA,” p. 84). Third, a meaningSuch systems pay dividends for all involved. They spur early action to protect
ful procedure serves as an important “safety valve”
prisoners from future abuses; they give managers the information necessary to
for prisoners and staff, and its absence encourintervene; and they even protect misbehaving staff persons by signaling when
ages prisoners to create their own systems of acintervention is necessary, before more serious troubles arise. As Michael Gennaco,
countability that might involve disorder and even
chief attorney at Los Angeles County’s Office of Independent Review, told the
violence. As former prisoner A. Sage Smith told
Commission, “One thing . . . that does exist in some of the more progressive police
the Commission, “The guys who think somedepartments is a computer tracking system of employee behavior. . . . Unfortunately,
body is listening to them don’t cause problems.
this kind of model hasn’t moved over to the correctional setting, and there’s no
When they don’t think that they’re being heard,
reason why it can’t.”
that’s when they cause problems.”
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Nearly every prison and most jails have a procedure for receiving prisoners’ grievances. However, the Commission heard that many are ineffective. The Massachusetts Governor’s Commission found that “grievances
•	The number of grievances and
are frequently denied on procedural issues rather than substance, even
complaints filed by prisoners
when they involve allegations of abuse by staff ” (Commonwealth of Mas•	The types of problems prisoners
sachusetts Governor’s Commission 2004). Leslie Walker, executive direcare describing
tor of Massachusetts Correctional Legal Services, described other ways
that grievance systems can be meaningless or even obstructive: “It begins
•	What actions are taken as a result
with the withholding of pens and paper in segregation. It begins with not
of prisoners’ grievances and
making copies of prisoners’ grievances so that they have no record that
complaints
they have made it and then throwing them away. . . . The whole system
lacks confidentiality. . . . The assaulted prisoner who was brave enough to
report it needs to know that report is going to be held in confidentiality,
which is not currently happening.”
Some corrections administrators understand the critical importance of
confidentiality and other protections from reprisal. Rhode Island corrections Director A.T. Wall described “multiple channels to communicate
problems,” including providing “deposit boxes [for grievances] that can
only be opened by special staff.” Federal Bureau of Prisons Director Harley
Lappin told the Commission about extensive protocols, including referring
all allegations of staff misconduct to the Department of Justice’s Inspector
General to ensure some external accountability for the safety and soundness of the grievance process. Many grievance systems lack such protection, however, and even good practices like these may not be enough to
assure prisoners that they will be protected from
retaliation for filing a complaint alleging staff
Fearing Retaliation
misconduct. In describing a dozen jury verdicts
Preliminary findings from a survey of prisoners by the Correctional Association
and judicial findings, John Boston, director of
of New York suggest that more than half of prisoners who file grievances report
the Prisoners Rights Project of the New York
experiencing retaliation for making a complaint against staff. According to prisoner
City Legal Aid Society, pointed to “a recurrent
rights attorney Leslie Walker, “Retaliation can take many forms, including the
pattern in American prisons of threats and relikelihood of remaining in segregation for longer periods of time, poor classification
taliation against prisoners who file grievances
decisions that keep that prisoner in a higher security environment where they
and complaints” (Boston 2006).
cannot get any program or are not near their families, the very real fear of physical
Encouraging corrections staff to report misretribution wherever they go in the system, and should the grievance be denied, at
conduct and protecting staff from reprisals is
least in Massachusetts, the fear of discipline for filing a false grievance.”
also critical for operating prisons and jails that
Corrections officers also fear retaliation by fellow officers if they report
are safe and demonstrate respect for the rule of
wrongdoing. Former warden Ron McAndrew explained: “That’s very intimidating
law. Many corrections officers and managers told
to walk out to your car in a large parking lot where there are three or 400 cars, and
the Commission that most staff would be eager
there are 10 or 12 goons sort of surrounding your car. They don’t say a word to you,
to report unsafe and abusive conditions—even
they just look at you real hard like, ‘You better be getting the message, bubba.’”
when those conditions involve misconduct by
Recently, the California legislature found that general whistleblower laws were
their peers—if they felt safe doing so. But, all too
“insufficient to protect” corrections staff who “choose to expose the wrongdoing
often, they neither feel safe, nor do they report.
of coworkers or their superiors” and that “additional protections” were necessary;
Corrections officers feel particularly vulnerit instructed the corrections department to develop those protections, along with
able to retaliation from other officers. As Mia clear code of conduct that set forth the “duty to report wrongdoing” (Senate Bill
chael Gennaco, chief attorney at Los Angeles
1431 §1 2004).

Missing Data

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County’s Office of Independent Review, told the Commission, “There’s a
significant pressure placed on a deputy or any other correctional officer not
to report in order to remain within the group of colleagues that are there
backing them up every day with regard to a very dangerous occupation.” In
his Commission testimony, former Florida prison Warden Ron McAndrew
explained that the majority of officers “did the work as required by rules
and regulations, but often with the exception of not reporting certain incidents observed . . . for fear of job loss or retaliation.” Those fears are based
on such incidents as “serious telephone threats,” or rogue officers’ “meeting

“There’s a significant pressure placed on a deputy or any other
correctional officer not to report [misconduct] in order to remain within
the group of colleagues that are there backing them up every day
with regard to a very dangerous occupation.”
Michael Gennaco, chief attorney,
Los Angeles County
Office of Independent Review

a staff member suspected of ‘informing’ at his personal vehicle at quitting
time,” he explained. It is not only custody staff who fail to report misconduct. According to Dr. Robert Cohen, who was medical director of New
York City’s jails, doctors and nurses frequently fail to report signs of violence that they observe. Such failures to report should result in sanctions.
Everyone who works in a prison or jail must be required to report misconduct by other staff or by managers. Administrative and, in egregious
instances, criminal sanctions must be used to ensure reporting. But this requirement must be backed up with an unrelenting commitment to protect
people from retaliation. A.T. Wall told the Commission about some of the
strategies he uses, from a credible investigation to serious consequences for
retaliation, adding, “That’s when people know you mean it.” The Commission urges corrections departments to develop these protections and others.
Meaningful and safe grievance and complaint procedures for prisoners and
reporting requirements and protections for staff are a critical part of professional accountability and require much greater attention.

strengthen accountability within the profession:
recommendations recap
1.	 Monitor practice not just policy. Ensure that American Correctional Association
accreditation more accurately reflects practice as well as policy.
2.	 Strengthen professional standards. Support and improve American Correctional
Association standards.
3.	 Develop meaningful internal complaint systems. Corrections managers should
strengthen the systems that allow them to listen to those who live and work in
prisons and jails.

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Educate and Involve
the Public
“ for too long only we in corrections talked to each other

about our policies and approaches,” Richard Seiter, former director of
corrections in Ohio and professor of criminal justice, testified. “It is critically important in my mind that those outside of corrections and outside
government in the corporate, religious, not-for-profit, academic, and media
world come together to discuss our nation’s correctional policies.” Mr.
Seiter was part of a chorus of witnesses—from corrections administrators
and union officials to advocates and former prisoners—to emphasize that
it takes an educated public to demand reform of America’s prisons and jails.
There are two avenues by which interested individuals as well as organized
citizens’ groups might better understand what is happening behind the
walls of prisons and jails: direct access to facilities and greater access to
information about facilities through a free and informed press.

recommendations
1.	 Encourage visits to facilities.
2.	 Strive for transparency.

1

Encourage visits to facilities. Create opportunities for individual
citizens and organized groups, including judges and lawmakers,
to visit facilities.
“The public I think understands to some degree what our work is about,
but you know, they don’t have an opportunity to really see it up close and
personal. So they only know the horror stories sometimes that occur,” said
Theodis Beck, secretary of the North Carolina Department of Correction. Providing opportunities for the public to visit facilities serves this
educational purpose. Visitors can witness and even sense the strictures of
prison life for the incarcerated as well as the pressures on staff; they can
begin to understand both officers and prisoners as individuals, perhaps
breaking down stereotypes; they can learn about problems as well as good
practices and, if they return to the facility, they can see how things do or
do not change over time.
“If [the Commission] wants to know what is really happening in our
prisons and jails, I ask that you take the time to visit,” said Jeffrey Beard,
secretary of the Pennsylvania Department of Corrections. This invitation
was one of several that the Commission received over the course of our
year-long inquiry. We accepted Secretary Beard’s invitation and visited the
impressive, program-intensive maximum security prison in Graterford. An
important part of this visit was a lengthy and frank private discussion with
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“The public I think
understands to some
degree what our work is
about, but you know,
they don’t have an
opportunity to really see
it up close and personal.
So they only know the
horror stories sometimes
that occur.”
Theodis Beck, secretary of the
North Carolina Department of Correction

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a group of long-term prisoners. At Graterford and elsewhere, Commission
members were impressed with the openness, sincerity, and constructiveness
of established prisoners’ groups. The opportunity to talk privately with such
groups should be part of any prison visiting program, as should talks with
staff, individually and in small groups.
Visits by the public to correctional facilities can also serve as an informal
monitoring mechanism. They provide an opportunity for corrections staff
and prisoners to discuss their concerns, and they bring an independent
eye into closed institutions. Sheriff Michael Ashe of Hampden County,
Massachusetts, testified that his county’s jail system has over 500 volunteers coming into the facilities. He stressed that “such openness to the
community is a de-facto monitoring agent . . . adding 500 sets of eyes that
those who would perpetrate violence and abuse must avoid—in a sense, 500
surveillance cameras from the larger community.” Federal District Judge
Myron Thompson urged visitation by a specific group of outsiders—state
judges responsible for sentencing: “If state judges were required to visit
state prisons on a fairly regular basis . . . I think it would make them more
transparent, and I think it would make the judges more aware of what’s
going on,” and perhaps inspire some shared accountability for the conditions to which they sentence people.
Corrections administrators, who are responsible for maintaining the
security of their facilities, are sometimes apprehensive about opening their
doors to the general public, and all are attuned to the related security concerns. They may be skeptical about the motives of visitors, thinking that
they harbor biases, or as corrections directors A.T. Wall and Harley Lappin
pointed out, that “naïveté” on the part of an individual will make the person
susceptible to being deceived or manipulated by prisoners.
These concerns are not insurmountable. Citizens’ visiting groups developed in England along with the first prisons, and the institutions traveled
together to this country. These groups have taken many forms, from informal opportunities for observation to formal boards or commissions of
citizen leaders. The latter approach was described by University of Texas
at Dallas professor James Marquart who reminded the Commission that,
at one time, the Texas prison system was known as the “black hole of Calcutta,” a “violent, dangerous world” from which the public was excluded.
“But that changed, and it changed as a result of leadership within the wider
community. Prominent bankers, politicians, school teachers, university
types came in and shone light on what was going on within that environment. . . . Today it’s the same issue. We have 160,000 people that are
locked up. We’ve bottomed out, you know. We can’t build our way out of
this. We need people, prominent people, who are going to come out and
say enough is enough.”
The Correctional Association of New York, the Pennsylvania Prison
Society, and the John Howard Association of Illinois have long brought
citizens to visit and monitor facilities in their respective states, without
compromising safety or security. Indeed the visits may help to promote

safety. Jack Beck, of the Correctional Association, has observed how visits can defuse prevailing tensions: “Communication with inmates is very
affirming to them. . . . At least [there is] someone to hear their grievance
rather than just be frustrated.” These three organizations thoroughly prepare people for their visits and encourage ongoing, rather than one-shot,
participation. Other programs include the Corrections Citizens’ Academy of the Orange County (Florida) Corrections Department, which of-

The Texas prison system was known as the “black hole of
Calcutta,” a “violent, dangerous world” from which the public
was excluded. “But that changed, and it changed as a result
of leadership within the wider community. Prominent bankers,
politicians, school teachers, university types came in and shone
light on what was going on within that environment.”
fers the public a 13-week program focused on the department’s functions
and staff, and special orientation programs in Iowa and New Jersey for
the family members of corrections officers.
Citizen visits to correctional facilities have at least one other important
benefit. The presence of individuals from the surrounding community
helps to normalize the prison environment. As former prison chaplain
Jacqueline Means told the Commission, it gives people in prison a sense of
the broader world and hope for their future in that world. For all of these
reasons, correctional agencies should strongly encourage members of the
public to visit prisons and jails.

James Marquart, professor,
University of Texas, Dallas

2

Strive for transparency. Ensure media access to facilities, to
prisoners, and to correctional data.
Much of what the public knows about prisons and jails comes through
the press. When journalists have the time and space to explore issues in
depth, they can engage and educate the public. In 2005, the New York
Times published a series of articles by reporter Paul von Zielbauer on the
serious failings of the private company that provides health care in New
York’s correctional facilities. Accounts of individual suffering and death
combined with detailed information about the operations of one of the
biggest private correctional health-care companies brought this issue to
the attention of ordinary people around the country. But the ability of
the press to provide the public with the depth of information necessary
to reach intelligent and informed opinions has been impeded by barriers
that prevent members of the media from visiting facilities, talking to staff
and prisoners, and reviewing official records.
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Press access cannot be unlimited, but the many valid security and privacy
concerns that exist must not be used to shield institutions from public scrutiny. While correctional systems differ in the degree to which they grant
media access, journalists have cited the following problems: denial of faceto-face interviews with specific prisoners, even with the prisoner’s consent;
a near total lack of access to supermax prisons and segregation units; restrictions on their ability to freely visit facilities; the lack of confidentiality
for interviews with prisoners and staff; the failure to protect prisoners from
retaliation for speaking with the press; barriers to using cameras and audio

Alan Elsner, Reuters journalist and author of Gates of Injustice,
compared “covering the U.S. prison system” to “what it used to be
like trying to cover the former East Bloc, where one’s access was
limited and movements were strictly monitored.”
recorders, and in some cases paper and pens; and a sense that responses to
their requests are arbitrary rather than reflecting a thoughtful, consistentlyapplied policy (Gest 2001).
Alan Elsner, Reuters journalist and author of Gates of Injustice, testified
that such limits on his access to facilities and prisoners brought him to
the point where he “made a deliberate decision to stop making these visits
because I came to the conclusion that their journalistic usefulness for me
was very difficult, had run out, was about a zero.” He compared “covering the U.S. prison system” to “what it used to be like trying to cover the
former East Bloc, where one’s access was limited and movements were
strictly monitored.” As a journalist, Elsner felt that it was better to forego
the story than to base it solely on what the facility wanted him to know:
“They basically took you to where they wanted to take you and showed
you what they wanted you to see and had you speak to who they wanted
you to speak to.”
An informed public and, indeed, representative government depend
on the watchdog role offered by an independent and objective press. The
ability of the press to fulfill this role depends in turn on the broadest possible access to correctional facilities, consistent with valid concerns about
security. Policies governing media access must be objective, streamlined,
and consistently applied rather than being dependent on friendly relations
between journalist and warden. A speedy appeals process should be developed so that the media may have recourse when their requests for access
are denied, and correctional systems should maintain records of applications and denials to monitor practices. According to Ted Gest, president
of Criminal Justice Journalists, the Society of Professional Journalists has
identified North Carolina and Oregon as having what it considers reasonable media access policies in their state systems.
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Direct access to facilities is not the only important form of media access. Prisoners should be able to contact journalists directly, by phone and
through confidential written correspondence, just as they can with their
lawyers. As Margaret Winter of the National Prison Project told the Commission, “That would be a very, very significant thing if prisoners had direct
access to the press—not simply through letters, but by telephone, in person
so that their voices could actually be heard.”
Freedom of information laws are also important tools in opening
government to scrutiny by the press and thus by the public. Perhaps
even more than other government bodies, correctional agencies resist
freedom of information requests. Michael Gennaco, chief attorney at
Los Angeles County’s Office of Independent Review, testified that “corrections managers…read the interpretation of the statutes very narrowly.”
Freedom of information laws should be read broadly, to fulfill their purpose—providing public access to information about how government
is functioning. Exceptions, such as for ongoing investigations and to
preserve confidentiality, should be made only when necessary. And the
laws should apply equally to private companies that operate prisons or
jails under government contract, as specified in pending legislation that
would make private companies contracting with the Federal Bureau of
Prisons subject to the Freedom of Information Act (FOIA) (The Private
Prison Information Act of 2005, HR 1806). Free and unfettered access to
records should be made a part of a renewed commitment to transparency,
one grounded in broad media access.

educate and involve the public: recommendations recap
1.	 Encourage visits to facilities. Create opportunities for individual citizens and
organized groups, including judges and lawmakers, to visit facilities.
2.	 Strive for transparency. Ensure media access to facilities, to prisoners, and to
correctional data.

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99

“We have a fixed resource base, and we
continue to pour more people into it.”
Richard Stalder,
Louisiana corrections secretary
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k n o w l e d g e a n d d ata

IV. Knowledge and Data
one of the most difficult tasks this
C ommission faced was to ascertain what is
known today about safety and health in America’s
correctional facilities and the prevalence of violence
and abuse. To do that, we asked a wide array of
experts to tell us what they have learned over
their years of experience. We spent as much time
reviewing available research and data, which

The prevailing view
of correctional
facilities as shrouded
and unknowable
reflects the shortage
of meaningful
and reliable data
about health and
safety, violence and
victimization.

also turned out to be a task of critical analysis
and interpretation. § There are stunning gaps in
the research and data about violence and abuse.
Throughout this report we have pointed out many
of these missing pieces. Even where numerical
evidence exists, there are no easy answers to
the most controversial questions. Perceptions
and expectations play a large role in shaping
opinions about how much is known and what
it means. As Professor Michele Deitch testified
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101

about issues of safety and abuse, “We have very little way to know what’s
going on; we end up dealing with anecdotes. . . . [As] to how widespread
these problems are, we don’t have that kind of information.”
The prevailing view of correctional facilities as shrouded and unknowable reflects the shortage of meaningful and reliable data about health
and safety, violence and victimization; ignorance about what information
is available; and the difficulty of accessing and interpreting much of the
data that corrections departments collect but do not widely disseminate or
explain. There are real obstacles to overcoming each of these problems, but
it is possible and necessary to know much more than we do today. Where
research and data are weak, they can be strengthened; where information
is available it can be widely shared.
Corrections administrators want to base their operational decisions on
sound information and are taking steps on their own to improve data collection and performance measurement. Equally important, there must be
public demand for more and better information about the health and safety
of our correctional facilities. Without it, we cannot assess successes and
failures, ensure accountability, promote responsible and innovative leadership, and help people learn from one another how to run safer and more
effective institutions. In this section, the Commission offers three recommendations for improving our knowledge and data, so that crucial public
policies can be grounded in complete and reliable information.

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Measure Safety and
Effectiveness
the commission heard from experts both inside and outside
the corrections profession about significant weaknesses and blind spots in
the data related to the Commission’s areas of inquiry. That body of data is
weak in three ways: First, crucial information is either not being collected
or is not reported nationally. Second, differences—sometimes extreme—in
how state and local jurisdictions define specific conditions and events
render it impossible to make sound comparisons across the country. And
fluctuating definitions within a single state or local corrections system
make it difficult to dependably track trends over time. Third, much of the
data is shallow, based only on conditions and events that are captured in
official records and sometimes failing to reflect important distinctions,
such as the difference between use of force and excessive use of force. This
is a problem particularly in the realm of violence and abuse, where events
are underreported for many reasons. Overcoming this particular weakness
is not easy, but it is possible to produce official counts that more closely
reflect reality. Just as important, we need more in-depth, qualitative studies
of violence and abuse in correctional facilities as an important check on,
and way to understand, baseline data about prevalence.
There are other failings. Efforts to use data to make correctional facilities
safer and more effective are uneven around the country and just beginning
to gather momentum, even in jurisdictions where data collection is more
advanced. And lawmakers in many states do a poor job drawing on the best
available knowledge and data to forecast the impact of proposed legislation.
The recommendations described below address these problems and provide
concrete ways to produce stronger measures of the safety and effectiveness
of America’s prisons and jails.

recommendations
1.	 Develop nationwide reporting.
2.	 Fund a national effort to learn how
prisons and jails can make a larger
contribution to public safety.
3.	 Require correctional impact statements.

1

Develop nationwide reporting.  Federal legislation should
support meaningful data collection, and states and localities
should fully commit to this project.
There are many different ways to define and count things. Consider something as straightforward as demographic information. Most correctional
systems provide separate counts of Latino prisoners and staff, but in Georgia, for example, most Latinos are counted among the population of “white”
prisoners. Now consider something a little more difficult to define, such as
measure safety and effectiveness

10 3

segregation. The living conditions in most supermax prisons are just as stringent—and often more stringent—than conditions in high-security “segregation” units in other prisons. Yet national counts of prisoners in segregation
most likely do not capture the majority of people incarcerated in supermax
facilities. The Commission heard testimony that this expensive form of confinement is overused. To reduce it, corrections administrators and lawmakers
need accurate measures to monitor progress toward that goal.
Finally, consider something very difficult to define and count: A prisoner dies while officers are forcefully removing him or her from a cell (a
“cell extraction”). That event could be defined and counted as an accidental
death (the same as a death from falling down a flight of stairs), a negligent
or reckless homicide, or even a murder. How it is
Crowding: Different Stories in the Data
counted depends on the circumstances, but those
Official measures show a decline in crowding nationally after a crisis in the 1990s.
circumstances are likely to be defined differently
In 1995, state prisons were at 114 percent of their highest capacity and dropped
in different states and facilities. Even in the same
to 99 percent of capacity by 2004 (Harrison and Beck 2005). Are corrections
facility definitions change over time as leadership
professionals, experts, and the media wrong when they blame violence on
and the institutional culture change.
crowding? Or do we need to look more closely at the data?
While deaths that occur during cell extractions
One explanation for the decrease in crowding by official counts is that
are rare events, non-lethal assaults among prisinstitutions increased their capacity by double- and triple-celling prisoners.
oners and between prisoners and staff are much
Professor Craig Haney testified that when he began studying prisons 30 years
more common, yet the differences in definitions
ago, double-celling was regarded by academics and corrections administrators
are even more disparate around the country. Allen
as an “unmitigated evil.” “Nothing has changed except for the numbers of people
Beck, chief statistician at the U.S. Department
that we have in prison to shift that judgment. Nothing has changed in academia to
of Justice’s Bureau of Justice Statistics, told the
suggest that crowding is not harmful,” he said.
Commission that what constitutes a serious asStill, the entire decrease in crowding cannot be explained by this shift in
sault varies substantially across state and local syspractice. Even measured against a facility’s original “design capacity,” a number
tems. Beck went on to explain that our knowledge
that never changes, crowding declined from 125 percent of capacity in 1995 to 115
about levels of assaults nationally and variations
percent in 2004 (Harrison and Beck 2005). Many systems expanded their capacity
around the country are rough partly because of
by building new facilities and, in terms of available bed space, are less crowded
the many different definitions in play. Another
than they were 10 years ago. So, why are we still concerned about crowding?
key factor is variation in the reliability of internal
Crowding can occur even when facilities are less than full, as a result of
mechanisms for accurately recording and reportcircumstances ranging from a rise in the number of high-risk prisoners who need
ing information. To meaningfully track and comtheir own cells to a broken water pipe that makes cells uninhabitable. Equally
pare the numbers and rates of aggravated assaults
important, crowding is about more than physical space. Systems that now doublein facilities across the country, every institution
cell prisoners or that have added beds have not necessarily been able to make
must define an aggravated assault in the same way
parallel increases in numbers of staff and in productive activities, two factors that
and use the same “counting rules” to indicate what
affect safety. This suggests that the data on crowding do not capture the problems
should be counted and how (Gaes et al. 2004).
created by adding more and more people to a facility or system.
The difficulty of comparing data among states
Finally, national numbers mask variation among the states. While some state
and localities is a primary reason why the body
systems are less crowded by conventional measures, some of the largest systems
of national-level data is less comprehensive and
are more crowded. California, the nation’s third-largest prison system, is currently
rich than it should be. But there is another probat twice its capacity by some estimates, and the Federal Bureau of Prisons,
lem. While some state prison systems and large
the largest system, is at 140 percent of its capacity. Furthermore, some state
jails collect a wealth of information and closely
systems are simply shifting the problem by increasingly leaving larger numbers of
monitor trends, others—particularly smaller
sentenced prisoners in local jails.
jails—collect and monitor very little. There also
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are crucial pieces of information that very few systems routinely collect,
ranging from the time people spend in segregation, to complaints about
medical neglect, to how often force is used against prisoners belonging to
different racial groups, to offer three examples.
Government and academic researchers, as well as leaders in the corrections profession, are working to overcome the many obstacles to producing better and more useful data. The Bureau of Justice Statistics routinely
collects more quantitative data from corrections departments nationally
than any other single agency or organization. Currently, BJS is helping
the Association of State Correctional Administrators (ASCA) to develop
uniform definitions of key conditions, characteristics, and events that
directors of all 50 state correctional systems could use to monitor performance (see “Performance-Based Measurement” on p. 106).
Congress should pass legislation that builds on this effort and others
by funding uniform, nationwide reporting, and state legislatures should
mandate compliance with the national reporting requirements. All jails
and prisons should be required to record and report essential information
related to safety and health. ASCA’s project is an excellent starting point.
With start-up funding from the federal government, particular state and
local systems might serve as laboratories for developing and testing definitions and measurement tools. Many of these things are very difficult to
measure accurately, so the federal legislation must include a plan to provide
technical assistance to states and localities.
Because lawmakers and the public will use this information to make tough
choices about law, policy, and spending, decisions about exactly what to collect and how to define each piece of information must be informed by a broad
base of expertise. This cannot be a project for any one profession to complete
alone. A broad base of concern and expertise will guarantee, for example, that
we are able to collect national data on both sanctioned and excessive uses of
force by corrections officers, rates of infectious and chronic diseases, and a
host of other issues that influence safety inside the walls and beyond.
While administrative reporting is crucial and must be improved, it
should never be the sole measure of safety. Measuring certain behaviors
and incidents in prisons and jails—particularly violence—is extremely
difficult because it is underreported by both victims and assailants; corrections staff do not always know about threats, fights, and assaults; and
different interpretations of behavior can lead to subjective decisions about
what to report and what not to report (Cooley 1993, Edgar and O’Donnell
1998, Hewitt et al. 1984, Sykes 1958, Wright 1991, Resig 1998). BJS currently
conducts surveys of inmates every five years that include a few questions
related to victimization. Questions should be added to the survey of inmates to expand the picture it provides of dangers and harms that prisoners
experience, and this survey should be adequately funded by Congress.
Finally, some of the most valuable knowledge we have about corrections
is the product of in-depth and sometimes qualitative research conducted
by academics and policymakers inside our correctional institutions. Federal

To meaningfully track and
compare the numbers
and rates of aggravated
assaults in facilities
across the country, every
institution must define an
aggravated assault in the
same way and use the
same “counting rules” to
indicate what should be
counted and how.

measure safety and effectiveness

105

legislation should encourage research, both through increased funding to
the National Institute of Justice and by making prisons more accessible
to researchers.

2

Fund a national effort to learn how prisons and jails can make
a larger contribution to public safety. The federal government
and states should invest in developing knowledge about the link
between safe, well-run correctional facilities
Performance-Based Measurement
and public safety.
With funding from the federal government—through the National Institute of
Correctional institutions are expected to make
Justice, the Correctional Program Office, and the Bureau of Justice Statistics—the
our communities safer. However, high rates of
Association of State Correctional Administrators (ASCA) is developing uniform
incarceration and little investment in rehabilitadefinitions to measure performance in state correctional systems across the
tion fuel recidivism and increase problems for
country. For decades, BJS has had the difficult task of harmonizing data from
the communities hit hardest by incarceration
every jurisdiction and has had to rely on the voluntary cooperation of state and
(MTC Institute 2003). If correctional systems
local correctional systems (the one recent exception being federally mandated
are to perform a public safety function, the pubreporting of sexual violence in compliance with the 2003 Prison Rape Elimination
lic must be able to hold institutions at least partly
Act). BJS’s chief statistician, Allen Beck, is drawing on the agency’s experience to
accountable for the impact that former prisoners
assist ASCA.
have on the communities to which they return.
In the first wave of the project, ASCA defined select measures in four broad
That requires measures of success that can be
areas: public safety, institutional safety, mental health and substance abuse, and
compared across systems—including recidivism,
offender profile data. ASCA consulted seven different research-based models for
family reunification and employment after remeasuring performance in correctional institutions and systems—models that are
lease—and knowledge about the conditions of
generally more comprehensive than the initial set of measures ASCA developed.
confinement that influence those outcomes.
For instance, at least one of the models consulted includes “perception of danger”
In the 1970s policymakers shifted the goals of
by prisoners among its safety measures, while ASCA’s chosen measures of physical
our prisons and jails away from rehabilitation todanger are limited to substantiated sexual assaults and assaults that result in
ward incapacitation and punishment (Allen 1998,
serious injury, those that require stitches, setting broken bones, tending to a
Tonry 2001). At the same time, Professor Robert
concussion or something more than bandaging a wound (Wright et al. 2003).
Martinson released a study that was published in
After developing its initial set of uniform definitions, ASCA surveyed correctional
the New Republic and the Public Interest, suggestagencies to gauge how closely the new definitions matched definitions in use
ing that rehabilitation had little impact on recidiaround the country. In terms of assaults among prisoners, for example, there was
vism (MacKenzie 1997). Along with the dramatic
very little match: Only 17 percent of respondents used the same definition, and
rise in the prisoner population, there has been
only eight percent used a comparable definition to measure prisoner-on-staff
decreasing support from lawmakers for improvsexual assaults (Wright et al. 2003).
ing the education and skills of people in prison.
Six states are currently piloting the project, and ASCA has produced a manual
Giving up on rehabilitation was a mistake. Our
for other states to encourage them to begin using the uniform measures.
soaring prison costs coupled with a national reASCA’s project has the potential to produce data that can be reliably compared
arrest rate of 67 percent and a re-incarceration
across jurisdictions, but the Association acknowledges that these measures are
rate of 52 percent three years after release is an
only a beginning. ASCA’s efforts, along with the established work of BJS and
indication of how far wrong we have gone (Lanother researchers, continues despite the lack of national mandatory reporting
gan and Levin 2002).
requirements for correctional facilities. This absence remains a significant
One of the weaknesses of the early research
obstacle to producing data that offer a complete and meaningful national picture
on rehabilitation is that the studies used overly
of the safety and effectiveness of America’s prisons and jails. Mandatory national
simplistic measures of success and measured the
reporting is an important step, one that requires a change in the law and additional
outcomes of programs that were poorly implefunding and support to succeed.
mented (MacKenzie 1997). Researchers have
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Strengths and Weaknesses of Key Data
research

source

frequency

strengths

weaknesses

Census of
adult state
and federal
correctional
facilities,
and jails

Bureau of
Justice
Statistics

Conducted
every five years

Facility-level demographic
information about prisoners; detailed information about
facilities, programs, health and
safety conditions; and particularly
detailed information from jails
about drug testing policies
and practices, inmate work
assignments, education and
counseling programs, and the
prevalence of HIV/AIDS and
tuberculosis.

• Budgetary constraints mean the

Provides individual-level data from
prisoners about demographics,
circumstances of current confinement, criminal history, history of
alcohol and substance abuse,
family history, and very limited
information about victimization in
prison or jail.

• Budgetary constraints mean survey

Most recent
published
data: state
and federal
facilities­—
2000;
jails—1999

•
•
•
•

census is conducted every five years
and results are often published years
later.
Relies solely on administrative
records, which can be weak.
Definitions differ across jurisdictions,
so comparisons can be misleading.
Some data provided by states is
inaccurate and cannot be validated.
Few reliable measures of non-deadly
violence and no measure of assaults
by staff against prisoners.

Survey of
inmates in
state and
federal
correctional
facilities,
and jails

Bureau of
Justice
Statistics

Survey on
sexual
violence

Bureau of
Justice
Statistics

National survey
of administrative records
in 2004
National survey
of prisoners
planned

Thorough survey of at least 10
percent of state and local correctional facilities nationwide, producing measures of sexual violence
against prisoners and staff.

• Although sexual violence is thought

Deaths in
custody in
state prisons
and jails

Bureau of
Justice
Statistics

Collected
quarterly

Thorough reports of deaths in
custody nationwide, with information about cause of each death,
location, and limited information
about circumstances.

• “Accidental injuries” includes deaths

Corrections
Yearbook

Criminal Justice
Institute, Inc.

Published annually through
2002
None available
after 2002

Nationwide data from prisons
and jails to describe populations,
facilities and their operations,
staff, budgets, and extensive
information about the work of
probation and parole offices.

• Definitions differ across jurisdictions,

Conducted
every five years
Most recent
published
data: state
and federal
prisoners­—
1997; prisoners
in jails—2002

is conducted only every five years
and results are often published years
later.
• Relies solely on self-reports, which
may be inaccurate.
• No questions about victimization by
staff.
• Questions about victimization have
changed from one survey to the next,
making it impossible to document
trends.
to be significantly underreported,
initial survey relies only on administrative records.

by positional asphyxiation during a
cell extraction.
• Homicides by staff are counted under
“other homicides,” masking the role
of staff in these deaths.
so comparisons can be misleading.
• Few measures of lower-level violence

and no measure of assaults by staff
against prisoners.
• Some data provided by states is
inaccurate and cannot be validated.
Continued on page 108

measure safety and effectiveness

107

Strengths and Weaknesses of Key Data (continued)
research

source

frequency

strengths

weaknesses

Performance—
based
measures

Association
of State
Correctional
Administrators

Measures
piloted in 2005
in six states

Uniform measures across jurisdictions that will allow for more
meaningful comparisons of state
systems.

• Currently, a narrow view of the victim-

Clear and precise counting rules.
Thorough measures of sexual violence and sexual misconduct.

ization of prisoners, including only
those incidents that result in very
serious injuries and substantiated
sexual assaults.
• No measure of assaults by staff
against prisoners, excessive use of
force, or homicides (although prisoner-on-staff assaults and homicides
are measured).

Corrections
Compendium

American
Correctional
Association

Monthly or
bi-monthly
journal

Research articles, book reviews,
and surveys on a broad range of
topics including health care, reentry, inmate grievance procedures,
and staff training (e.g., a 2002 survey asked all states to report riots,
disturbances, violence, assaults,
and escapes in their facilities).

• Much like the national data published

Administrative
records

Federal Bureau
of Prisons,
state prisons,
and local jails.

Ongoing

Individual state and local level data
that always includes information
about the population and budgets
and typically includes at least
some measures of violence.

• Large disparities in the quality of

NIC resources
for prisons and
jails

National
Institute of
Corrections

Ongoing

NIC-sponsored studies cover a
broad range of topics, including
facility operation, prison and jail
trends and issues, and issues of
concern to staff and prisoners.

• NIC surveys can suffer from the same

by BJS and CJI, the 2002 survey on
violence suffered from a lack of
uniform definitions across jurisdictions and incomplete reporting from
jurisdictions surveyed.

state and local data across the
country.
• Very little data available on assaults,
staff misconduct, or excessive uses
of force.
• Limited public access.
weaknesses as other national efforts
to collect data: lack of uniform definitions across jurisdictions, incomplete
reporting, and an inability to check
the validity of the data reported.

since developed more comprehensive measures of rehabilitative success,
and there is a growing understanding about what kinds of programs work
(MTC Institute 2003). Yet policymakers are still not paying attention. The
disconnect between what we know to work and the laws and policies legislatures implement is perhaps greater in this field than in any other area of
social policy ( Jacobson 2005).
Resourceful corrections administrators are already measuring the effectiveness of their programs. For example, the Pennsylvania Department
of Corrections, under the leadership of Jeffrey Beard, measures all of its
programs against a series of “principles of effective interventions,” such
as how well they perform risk and needs assessments and whether they
provide relapse prevention services (Gnall 2006). This kind of effort should
be regular practice in corrections, and both the measurement tactics and
the insights gained should be shared across jurisdictions. As Arizona corrections Director Dora Schriro put it: “I’m going to encourage us to strive
for more than reducing recidivism,” to measure not only whether prisoners
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“have stopped doing bad things” but also the extent to which correctional
systems assist prisoners to “acquire the skills to start doing good things.”
There is still a great deal to learn about what works in prison, the role of
safety, and how to define and measure success. The only way to improve our
knowledge is to measure the outcomes of a whole range of conditions of
confinement. This means we must tie our measures of success in the community to the conditions of confinement, such as spending on programming and the benefits of programming, institutional crowding, levels of
violence, staff-to-prisoner ratios, and hours and quality of officer training,
just to name a few key factors.
Congress should enact legislation that provides incentives for states to
track the success of former prisoners using the most sophisticated indicators of success: recidivism, employment, family unification, and other measures of stability. The results should then be analyzed alongside measures of
key conditions of confinement, which also should be made uniform across
jurisdictions. By knowing what works, we can hold correctional institutions
partly accountable for outcomes in the community, and those corrections
administrators can demand the resources and support necessary to run
their facilities in a way that contributes to public safety. This is a tremendously difficult task, but it is work that policymakers should embrace, as it
will contribute directly to public safety.

3

Require correctional impact statements.  The federal
government and states should mandate that an impact
statement accompany all proposed legislation that would change
the size, demographics, or other pertinent characteristics of prison
and jail populations.
We cannot hold corrections administrators accountable for the safety of
prisoners and staff, and for public safety, if we do not provide the resources
necessary to effectively manage their facilities. One of the most significant
challenges those administrators face is the size of the prisoner population, which has grown dramatically, without a corresponding increase in
resources. Over the past 25 years, the rate of incarceration for state and
federal prisons has increased three and a half times.
BJS Chief Statistician Allen Beck explained that “the growth in the prison
population is not about crime; it’s about how we have chosen to respond to
crime and that we’ve introduced sanctioning policies that have had profound
impacts on the size and composition of the nation’s prison population.” Administrators have had to deal with increasing numbers of mentally ill prisoners and prisoners facing extremely long and often life sentences. “We have a
fixed resource base, and we continue to pour more people into it. How do we
make those resources stretch to accomplish our goals?” asked Richard Stalder,
Louisiana’s corrections secretary and president of the Association of State
Correctional Administrators, when he testified to the Commission.
Every criminal statute, every sentencing policy, and every policy related
to probation and parole has consequences for the conditions inside our

The disconnect between
what we know to work
and the laws and policies
legislatures implement
is perhaps greater in this
field than in any other
area of social policy.

measure safety and effectiveness

109

prisons and jails. If we incarcerate more people with mental illness, our
prisons and jails need the resources to provide mental health care. If we
lengthen sentences or increase the number of life sentences, then correctional institutions need additional resources to provide medical care for
aging prisoners and the terminally ill. Before legislatures pass laws that
have consequences for the size, demographics, and needs of the incarcerated population, they should understand those consequences, inform the
public, and be held accountable for full and ongoing funding for the laws
they pass. A number of states currently require fiscal impact statements
as a prerequisite to legislation, and Virginia’s re1,000 Voices of Concern: Another Kind of Data
quirement is regarded as one with real muscle
Over the course of the Commission’s inquiry, we received more than 1,000 letters,
(Wilhelm and Turner 2002).
e-mails, and phone calls from current and former prisoners and their family
Legislators should also be held accountable
members and from officers and other staff. People from 46 states wrote to share
for the consequences of criminal justice policy
accounts of what they or their loved ones encountered inside our prisons and
on our communities. If we are going to ask
jails. Several letters described the good work of individual officers, physicians,
corrections to be responsible for the impact of
and administrators. Given the charge of the Commission, however, we naturally
confinement on a person’s success after release,
received many more accounts of problems and abuses. We were struck by the frank
we must also be sure that legislators understand
and passionate nature of those accounts, by the common threads of the reported
who they are sending to prison and the impact
problems, and by the desire of those who wrote to us about their own suffering to
those decisions have on particular communimake things better for others.
ties. Many of our laws have disproportionately
These accounts form an integral part of the Commission’s record. Indeed,
impacted poor communities in primarily urban
some people who submitted personal accounts also testified at the Commission’s
neighborhoods, and predictably so. Laws that
hearings. They include former Rhode Island Detective Scott Hornoff, who was later
have the consequence of incarcerating one in
exonerated and who described degradation and abuse; former Florida Warden Ron
every three or four African-American men in
McAndrew, who described a code of silence that allowed rogue officers to brutalize
some neighborhoods clearly impact the health,
prisoners with impunity; and Victoria Wright, who recounted a story of medical
resources, and long-term viability of those comneglect that led to the death of her husband in a California prison.
munities. For example, laws that establish “drug
 These and other stories were echoed many times over in the accounts we
free zones” have a disproportionate impact on
received. Prisoners and their family members described abusive conditions in
urban African-Americans and Latinos because
segregation units, physical and sexual violence, gangs, the treatment of Muslimoverlapping zones in densely populated urban
Americans after September 11, 2001, and humiliation. Many people described gross
areas render entire communities “prohibited”
medical neglect. One bereaved mother wrote, “Isidro was a human being who got
(Greene et al. 2006). Our policymakers should
less treatment than the dogs receive at the local animal rescue center.” Prisoners
be required to study these kinds of potential
described “ugly” reprisals for speaking the truth, and officers told us about losing
consequences before they vote, and they should
their jobs after reporting abuses by fellow officers. Inadequate treatment for the
be required to publish those studies so that citimentally ill, racial discrimination, and crowding were among the other concerns
zens can understand the consequences and exraised in numerous testimonials. One woman wrote, “We are packed in, eight
press their views.
women to each small cell, originally built to hold four.”
Congress and every state legislature should be
Although they are a tiny chorus among the vast number of people who have
required to review and publish statements that
experienced or come to know life in America’s prisons and jails, these testimonials
explain the impact of any proposed legislation
put human faces on the problems. They are a powerful reminder of the dizzying
that would influence correctional systems and
array of issues the Commission confronted over the course of a year. Informed by
the community.
these accounts and others like them, the Commission’s recommendations are an
attempt to understand, address, and eventually eliminate the problems that affect
prisoners, staff, and their families and communities.
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The Unequal Impact of Incarceration
Nationally, compared to whites
African-Americans are incarcerated
at a rate roughly seven times higher
and Latinos at a rate roughly three
times higher.

14
1

At the local level, the differences
are starkly revealed. In New Haven,
for example, incarceration rates
in poor African-American and
Latino neighborhoods are many
times higher than nearby,
whiter and more affluent
neighborhoods.

Neighborhood
beaver hills
business district
dixwell
dwight
east rock
east shore
edgewood
fair haven
heights
hill (4 city point)
long wharf
newhallville
prospect hill
westhills
westville
wooster square
yale

12

13

3

15
7

8
17

4

2

Number

% AfricanAmerican

%
Latino

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

64.59
25.74
73.68
38.59
8.75
10.53
61.98
26.10
28.67
41.87
30.13
92.07
32.41
54.99
21.12
27.62
8.33

8.00
13.81
12.29
20.97
7.18
17.49
12.95
51.13
21.51
45.61
50.24
4.69
4.95
11.10
4.93
19.27
7.25

9

5

10

16

11
6

prison admissions
per 1000 adults
New Haven, 2003
over 75
50.01 – 75
25.01 – 50
15.01 – 25
1.28 – 15
0.0

source: eric cadora and charles swartz, the justice mapping center.

measure safety and effectiveness: recommendations recap
1.	 Develop nationwide reporting. Federal legislation should support meaningful
data collection, and states and localities should fully commit to this project.
2.	 Fund a national effort to learn how prisons and jails can make a larger
contribution to public safety. The federal government and states should invest in
developing knowledge about the link between safe, well-run correctional facilities
and public safety.
3.	 Require correctional impact statements. The federal government and states
should mandate that an impact statement accompany all proposed legislation that
would change the size, demographics, or other pertinent characteristics of prison
and jail populations.

measure safety and effectiveness

111

Commission Witnesses
Hearing 1: Tampa, Florida
Kenneth Adams: Professor, University of Central Florida,

whose work focuses on the culture of violence in prison. John
Boston: Director, Prisoners Rights Project, New York City
Legal Aid Society. Donald Cabana: Former Warden, maximum
security prison in Parchman, Mississippi, and author of Death
at Midnight: The Confession of an Executioner. Jack Cowley:
Former Warden, Oklahoma Department of Corrections, who
is currently involved in faith-based reentry programming.
Garrett Cunningham: Former Texas prisoner who was raped
by a corrections officer. Alan Elsner: National Correspondent
for Reuters News Service. Glenn Fine: Inspector General of
the U.S. Department of Justice, overseeing all federal prisons.
Michael Gennaco: Chief Attorney for the Office of Independent
Review, which oversees the Los Angeles County Sheriff ’s
Department. Judith Haney: Lead plaintiff in a successful classaction lawsuit involving women strip-searched at a Miami jail.
Jeffrey Scott Hornoff: Former Rhode Island Police Detective
who was wrongfully convicted and incarcerated for six and a
half years. Steve Martin: Former Corrections Officer and former
General Counsel of the Texas prison system. Ron McAndrew:
Former Warden, Florida Department of Corrections. Anadora
Moss: Consultant whose work focuses on sexual abuse and
institutional culture. Barbara Owen: Professor, California
State University, Fresno, whose ethnographic research focuses
on women’s prisons. David Parrish: Detention Department
Commander, Hillsborough County (Florida) Sheriff ’s Office.
Donald Specter: Director of the California-based Prison
Law Office. Douglas Thompkins: Sociologist at the John Jay
College of Criminal Justice, New York, and former gang
leader and prisoner. Margaret Winter: Associate Director,
American Civil Liberties Union National Prison Project.

Hearing 2: Newark, New Jersey
Donald Joseph Baumann: A state Corrections Officer for 19 years

in Southern California. Pearl Beale: Mother of a young man
who was murdered in a Washington, D.C., jail while awaiting
trial. Jeffrey Beard: Secretary of the Pennsylvania Department
of Corrections. Allen Beck: Chief of the Corrections Statistics
Program at the federal Bureau of Justice Statistics. Devon Brown:
Commissioner of the New Jersey Department of Corrections (at
the time of the hearing), now Director of the Washington, D.C.,
Department of Corrections. James Bruton: Former Warden,
Minnesota Department of Corrections, and author of The Big
112

commission witnesses

House: Life Inside a Supermax Security Prison. Fred Cohen:
Consultant and court-appointed monitor in several states
specializing in prison mental health care. Dr. Robert Cohen:
Consultant working nationally and former Director of medical
services for the New York City jails. Thomas Farrow: A former
prisoner incarcerated for more than two decades in New Jersey.
Jamie Fellner: U.S. Program Director, Human Rights Watch,
and co-author of Ill Equipped: U.S. Prisons and Offenders
with Mental Illness. Dr. Joe Goldenson: Medical and Program
Director for the San Francisco County jails. Dr. Stuart Grassian:
A psychiatrist with extensive experience evaluating the mental
health effects of stringent conditions of confinement. Dr.
Robert Greifinger: Health-care policy and quality-management
consultant and principal investigator of the 2002 report to
Congress, The Health Status of Soon-to-Be-Released Inmates.
Dr. Gerald Groves: Former corrections psychiatrist in New
Jersey. Craig Haney: Professor at the University of California,
Santa Cruz, who recently published Reforming Punishment:
Psychological Limits to the Pains of Imprisonment. Gary Harkins: A
Corrections Officer for 25 years in the state of Oregon. Michael
Jacobson: Director of the Vera Institute of Justice and author
of Downsizing Prisons: How to Reduce Crime and End Mass
Incarceration, and former Commissioner of Correction for New
York City. Bonnie Kerness: Associate Director of the American
Friends Service Committee’s Prison Watch. Dr. David Kountz:
Medical Director of the Somerset County Jail in New Jersey.
Sister Antonia Maguire: A Catholic nun who has worked for 32
years with prisoners at three New York State prisons. Vincent
Nathan: An attorney, law professor, and national consultant
on prison management. Richard Stalder: Secretary, Louisiana
Department of Public Safety and Corrections, and President
of the Association of State Correctional Administrators. Daud
Tulam: A former prisoner who spent 18 years in isolation in
various New Jersey facilities. Arthur Wallenstein: Director,
Montgomery County (Maryland) Department of Correction
and Rehabilitation. Reginald Wilkinson: Director, Ohio
Department of Rehabilitation and Correction (at the time of
the hearing).

Hearing 3: St. Louis, Missouri
asha bandele: Married to a long-term prisoner in New York
State and author of The Prisoner’s Wife. Theodis Beck: Secretary,
North Carolina Department of Correction. Randall Berg:
Executive Director, Florida Justice Institute. Larry Brimeyer:

Deputy Director for Eastern Operations, Iowa Department of
Corrections. Lance Corcoran: Chief of Governmental Affairs,
California Correctional Peace Officers Association. Larry
Crawford: Director, Missouri Department of Corrections.
Brian Dawe: Executive Director of Corrections USA, a
corrections labor group. Robert Delprino: Professor, Buffalo
State College, and lead researcher of Work and Family
Support Services for Correctional Off icers and their Family
Members: A National Survey. Kathleen Dennehy: Commissioner,
Massachusetts Department of Correction. Sharon Dolovich:
Professor, University of California, Los Angeles, Law School,
where she teaches prison law and policy. Eddie Ellis: Director,
NuLeadership Policy Group at the City University of New
York, and a former New York State prisoner. Michael Hamden:
Executive Director, North Carolina Prisoners Legal Services,
Inc., and member of the American Correctional Association’s
Commission on Accreditation for Corrections. William Hepner:
Program Development Specialist for the Corrections Staff
Training Academy, New Jersey Department of Corrections.
Ronald Kaschak: Former Deputy Sheriff in Mahoning County,
Ohio. Mary Livers: Deputy Secretary for Operations, Maryland
Department of Public Safety and Correctional Services. Elaine
Lord: Former Superintendent, Bedford Hills Prison for women
in New York. James Marquart: Professor, University of Texas,
Dallas, and a former corrections officer. Patrick McManus:
National consultant on use of force and former Secretary,
Kansas Department of Corrections. Rev. Jacqueline Means:
Head of the Episcopal Church’s national prison ministry
program and former Prison Chaplain. Evelyn Ridley-Turner:
Treasurer, American Correctional Association, and former
Secretary, Indiana Department of Correction. Richard Seiter:
Executive Vice President and Chief Corrections Officer,
Corrections Corporation of America, and former Director,
Ohio Department of Rehabiliation and Correction. Frank
Smith: Field Organizer, Private Corrections Institute, a national
organization critical of the for-profit corrections industry.
Michael Van Patten: Correctional Sergeant, Oregon State
Penitentiary. Jeffrey Washington: Deputy Executive Director,
American Correctional Association. Lou West: Corrections
Officer, St. Louis County Justice Center. Mark Wrighton:
Chancellor, Washington University in St. Louis, Missouri.

Court-appointed monitor of the Los Angeles County Sheriff ’s
Department and President, Police Assessment Resource Center.
Alvin Bronstein: Director Emeritus and founder of the American
Civil Liberties Union National Prison Project. Pernell Brown:
Former member of the Bloods street gang who now works with
the Oregon Department of Corrections and community-based
organizations to reduce gang violence. James Byrne: Professor,
University of Massachusetts, Lowell, whose work focuses on
the causes, prevention, and control of institutional violence
and disorder. Silvia Casale: President, Counsel of Europe’s
Committee for the Prevention of Torture and Inhuman or
Degrading Treatment or Punishment. Matthew Cate: Inspector
General of California, responsible for investigating and auditing
the State Department of Corrections and Rehabilitation.
Gwendolyn Chunn: President, American Correctional Association.
Michele Deitch: Attorney and Adjunct Professor, LBJ
School of Public Affairs, University of Texas, Austin.
Anthony Delgado: Security Threat Group Investigation
Coordinator, Ohio Department of Rehabilitation and Correction.
Walter Dickey: Professor at the University of Wisconsin Law
School and former Secretary, Wisconsin Department of
Corrections. Katherine Hall-Martinez: Co-Executive Director,
Stop Prisoner Rape. Stephen Hanlon: Partner at the law firm
of Holland & Knight and pro bono counsel in numerous classaction lawsuits about unsafe and abusive conditions in prison.
Scott Harshbarger: Former Massachusetts Attorney General
and Chair of the Governor’s Commission on Corrections
Reform. Roderick Hickman: Secretary, California Department
of Corrections and Rehabilitation (at the time of the hearing).
Gary Johnson: Former Executive Director, Texas Department
of Criminal Justice. Jody Kent: Coordinator of the Los Angeles
County Jails Project for the American Civil Liberties Union of
Southern California. Harley Lappin: Director, Federal Bureau
of Prisons. Laurie Levenson: Professor, Loyola Law School, and
Director of the Center for Ethical Advocacy. Anne Owers: Her
Majesty’s Chief Inspector of Prisons, United Kingdom. Dora
Schriro: Director, Arizona Department of Corrections. A. Sage
Smith: Director of Client Services at the Center on Wrongful
Convictions, Northwestern University, and a former prisoner.
Hon. Myron Thompson: United States District Judge for the
Middle District of Alabama. Leslie Walker: Executive Director,
Massachusetts Correctional Legal Services. A.T. Wall: Director,
Hearing 4: Los Angeles, California
Rhode Island Department of Corrections. Victoria Wright:
Daniel “Nane” Alejandrez: Executive Director, Barrios Unidos, Wife of Jay Wright, a prisoner who died three months into his
a national movement that addresses youth, violence, and gangs, sentence. William Yeomans: Director of Programs, American
and a former prisoner. Michael Ashe: Sheriff of Hampden County, Constitution Society for Law and Policy, and former Deputy
Massachusetts. Jack Beck: Director of the Prison Visiting Assistant Attorney General at the Civil Rights Division of the
Project, Correctional Association of New York. Merrick Bobb: U.S. Department of Justice.
commission witnesses

113

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I.2. Provide Health Care

Allen, Scott, M.D. “Developing a Systematic Approach to Hepatitis C for
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American Correctional Association. Standards for Adult Correctional Institutions, 4th ed. Baltimore: American Correctional Association, 2003.
American Psychiatric Association. Psychiatric Services in Jails and Prisons:
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Ditton, Paula M. Mental Health and Treatment of Inmates and Probationers.
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Human Rights Watch. Ill Equipped: U.S. Prisons and Offenders with Mental Illness. New York City: Human Rights Watch, 2003.
Kupers, Terry A., M.D. Prison Madness: The Mental Health Crisis Behind
Bars and What We Must Do About It. San Francisco: Jossey-Bass, 1999.
Marquart, James W., Dorothy E. Merianos, Jamie L. Hebert, and Leo
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I.3. Limit Segregation
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II. Labor and Leadership
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———. November 2004 National Occupation Employment and Wage
Estimates, Community and Social Service Occupations. http://www.
bls.gov/oes/current/oes_21co.htm.
Byrne, James, Faye Taxman, and Don Hummer. “Examining the Impact
of Institutional Culture (and Culture Change) on Prison Violence and
Disorder: A Review of the Evidence on Both Causes and Solutions.”
Paper presented at the 14th World Congress of Criminology. Philadelphia, August 11, 2005.
Clem, Connie. “Results of Data Analysis: NIC Needs Assessment on
Correctional Management and Executive Leadership Development.” National Institute of Corrections, 2003. http://www.nicic.org/
Library/018898.
Coyle, Andrew. Managing Prisons in a Time of Change. London: International Centre for Prison Studies, 2002. http://www.kcl.ac.uk/depsta/
rel/icps/managing_prisons.pdf.
Finn, Peter. “Addressing Correctional Officer Stress: Programs and Strategies.” Washington, D.C.: National Institute of Justice, 2000. http://
www.ncjrs.gov/pdffiles1/nij/183474.pdf.
Franklin, Dick. “Culture Is . . . as Culture Does.” Prepared for “Contemporary Issues in Prison Management: Additional Readings.” National
Institute of Corrections, 1999. http://www.nicic.org/Library/015778.
Franklin, Raymond A. “The IADLEST National Decertification Database.” The International Association of Directors of Law Enforcement Standards and Training (IADLEST), 2005. http://www.iadlest
.org/nddreport.pdf.
Stephan, James J. Census of Jails, 1999. Bureau of Justice Statistics, 2001.
http://www.ojp.usdoj.gov/bjs/pub/pdf/cj99.pdf.

III. Oversight and Accountability
Administrative Office of the U.S. Courts. Judicial Facts and Figures, U.S. District Courts, Prisoner Petitions Filed by Nature of Suit. http://www.uscourts
.gov/judicialfactsfigures/Table406.pdf.

American Correctional Association. Standards for Adult Correctional Institutions,
4th ed. Baltimore: American Correctional Association, 2003.
Boston, John. “The Prison Litigation Reform Act.” February 27, 2006.
Training manuscript on file with the Commission.
Bureau of Justice Statistics. Census of State and Federal Adult Correctional
Facilities, 1995. Data available at National Archive of Criminal Justice
Data, 1998. http://www.icpsr.umich.edu/NACJD.
———. Census of State and Federal Adult Correctional Facilities, 2000. Data
available at National Archive of Criminal Justice Data. 2004. http://
www.icpsr.umich.edu/NACJD.
Citizens United for the Rehabilitation of Errants (CURE). “Campaign
to Promote Equitable Telephone Charges.” http://www.etccampaign
.com/etc/current_status.php.
Commonwealth of Massachusetts Governor’s Commission on Corrections Reform. Strengthening Public Safety, Increasing Accountability, and
Instituting Fiscal Responsibility in the Department of Correction, Final
Report. June 2004. http://www.mass.gov/Eeops/docs/eops/GovCommission_Corrections_Reform.pdf.
Feeley, Malcolm M., and Van Swearingen. “The Prison Conditions Cases
and the Bureaucratization of American Corrections: Influences, Impacts and Implications.” Pace Law Review 24, no. 2 (2004).
Fradella, Henry F. “A Typology of the Frivolous: Varying Meanings of
Frivolity in Section 1983 Prisoner Civil Rights Litigation.” Prison Journal 78, no. 4 (1998).
Gest, Ted. “Behind Prison Walls: Restricting Media Access.” Corrections
Today ( June 2001). http://permanent.access.gpo.gov/lps9890/lps9890/
www.corrections.com/aca/cortoday/june01/gest.html.
Her Majesty’s Inspectorate of Prisons. Expectations: Criteria for Assessing
the Conditions in Prisons and the Treatment of Prisoners. HM Inspectorate of Prisons, 2004. http://inspectorates.homeoffice.gov.uk/hmipris
ons/docs/expectations.pdf?view=Binary.
International Committee of the Red Cross. “ICRC Visits to Persons Deprived of Their Freedom: An Internationally Mandated Task, Implemented Worldwide.” 2004. http://www.icrc.org/Web/Eng/siteeng0
.nsf/iwpList265/4C2DE1E5ED3C7C9DC1256B660061123E.
Mumola, Christopher J., Substance Abuse and Treatment, State and Federal
Prisoners, 1997. Bureau of Justice Statistics, 1999. http://www.ojp.usdoj
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Scalia, John. Prisoner Petitions Filed in U.S. District Courts, 2000, with
Trends 1980–2000. Bureau of Justice Statistics, 2002. http://www.ojp
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Schlanger, Margo. “Inmate Litigation.” Harvard Law Review 116 (2003).
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———. “Department of Justice Activities Under the Civil Rights of Institutionalized Persons Act, Fiscal Year 2004.” http://www.usdoj.gov/
crt/split/documents/split_cripa04.pdf.
Court Decisions and Brief:
McGore v. Wrigglesworth, 114 F.3d 601, 603 (6th Cir. 1997).
Porter v. Nussle, 534 U.S. 516, 525 (2002).
Ruiz v. Johnson, 37 F.Supp.2d 855, 907 (S.D.TX. 1999); reversed in unrelated part by Ruiz v. United States, 243 F.3d 941 (5th Cir. 2001).
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outside/pdf/centers/woodford_ngo/Woodford_Amicus_brief.pdf.

IV. Knowledge and Data
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Institute of Justice, 2002.
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217-242.
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works cited

117

Acknowledgments

throughout our inquiry to examine safety and abuse in america ’ s prisons and
jails, the Commission has been supported by the Vera Institute of Justice in New York City. Vera
provided an institutional base for the Commission and vital assistance. While many Vera staff members contributed to our work, two individuals in particular deserve special thanks. Michael Jacobson,
Vera’s director, drew on years of expertise working in and studying the field of corrections to offer
valuable insights. Nicholas Turner, Vera’s chief program officer, provided guidance and unflagging
support. Finally, the Commission would not exist if Christopher Stone, Vera’s former director, had
not seen the need and opportunity for a national prison commission.
In addition to our offices in New York City, we had a second base of operations in Washington,
D.C., at offices generously donated by the law firm of Jenner & Block. Paul Smith and the rest of the
law firm offered the firm’s resources and invited us to stay until the Commission’s work is completed.
So very many people and institutions supported this Commission, and in countless ways. Our key
supporters are acknowledged below, and the individuals who testified at our hearings are listed on
pages 112-113. But there is another larger group of people and not enough space to mention each of
them by name. They are the thousands of people who wrote to us to share accounts of life in America’s correctional facilities, who attended our hearings, and who followed our work from a distance.
We have always kept you in mind, and we hope this report reaches and speaks to you.

Funders

Court Reporting Services

Charles River Fund
Ford Foundation
The Fund for New Jersey
JEHT Foundation
Open Society Institute
The Overbrook Foundation
The Robert W. Wilson Charitable Trust

TSG Reporting, Inc.
Veritext Spherion, Inc

Law Firms
Arnold & Porter LLP
Heller Ehrman White & McAuliffe LLP
Holland & Knight LLP
Jenner & Block LLP
Morrison & Foerster LLP
Pillsbury Winthrop Shaw Pittman LLP
118

acknowledgments

Event Hosts
WEDU Public Television
Essex County College
Washington University in
St. Louis School of Law
Loyola Marymount University
Ackridge Real Estate Services
Creative Coalition

Individuals
Elizabeth Alexander
Abeo Anderson
Angela Arboleda
Geoffrey Aronow
Gene Atherton
Katherine Bates
Ann Beser
Francesca Bowman
John Bowman
Robin Bronk
Diallo Brooks
Phyllis Busansky
Sheldon Busansky
Eric Cadora
Cerissa Cafasso
Burl Cain
Jean Callahan
Nora Callahan
Camille Camp
George Camp
Dawn Caradonna
Trish Carlson
Steve Chand
Jonathan Chasan
Joyce Conley
Ken Connor
Avi Cover
Vaughn Crandall
Keith DeBlasio
Anne De Groot
Maddy DeLone
David DiGuglielmo
William DiMascio
Vicki Divoll
Warren Dolphus
Robert Drinan
Kevin Driscoll
Una Elias
Althea Farrell
Christopher Fay
Joyce Feaster
Richard Ferruccio
Althea Francois

Ray Franklin
Charles Fried
Judy Freyermuth
C. Welton Gaddy
Jenni Gainsborough
Robert Gangi
Judi Garrett
Phil Glover
Andrew Goldberg
Roger Goldman
Jim Gondles
Elizabeth Gondles
Kara Gotsch
Judy Greene
Lawrence Greenfeld
David Hagy
Tom Hereford
Sheila Hill
Richard Hoffman
Martin Horn
Darryl Hunt
Steve Ingley
Chris Innes
Deborah Jackson
Richard Jerome
John Johnson
Nolan Jones
Garry Jones
George Kaiser
Thomas Kane
Jennifer Kaplan
Charles Kehoe
Steve Kenneway
Sarah Kerr
Anita Khashu
Lisa Kung
Terry Kupers
James Lanier
Gerald LeMelle
Arthur Leonardo
Jody Lewen
Thomas Lincoln
Margaret Love

Chuck Loveless
Brian Lowry
Thomas MacLellan
Nomi Maeyama
Mike Marette
Marc Mauer
Richard McCarthy
Andrew Molloy
Terrence Moore
Donald Murray
Alexandra Natapoff
Elizabeth Niehaus
Shpresa Oruchi
Carolyn Panzer
Amy Ralston
Lisa Ransom
Kate Rice
Andrew Rivas
Chase Riveland
E. Joshua Rosenkranz
Mary Ann Saar
Lovisa Stannow
Don Stemen
Lara Stemple
Bryan Stevenson
Julie Stewart
Mark Stull
Charlie Sullivan
Christina Swarns
Scarlett Swerdlow
Nkechi Taifa
Morris Thigpen
L. Jackson Thomas, II
Hans Toch
Pam Webb
Joe Weedon
Steve Wellner
Sarah Wilkinson
Pete Wilson
Genevieve Wood
Jeanne Woodford
Elwood York, Jr.
Malcolm Young
acknowledgments

119

120

commission recommendations
i. conditions of confinement
Prevent Violence
1.	 Reduce crowding. States and localities must commit to
eliminating the crowded conditions that exist in many of
the country’s prisons and jails and work with corrections
administrators to set and meet reasonable limits on the
number of prisoners that facilities can safely house.
2.	 Promote productivity and rehabilitation.  Invest in
programs that are proven to reduce violence and to change
behavior over the long term.
3.	 Use objective classification and direct supervision.
I ncorporate violence prevention in every facility’s
fundamental classification and supervision procedures.
4.	 Use force and non-lethal weaponry only as a last resort.
Dramatically reduce the use of non-lethal weapons,
restraints, and physical force by using non-forceful
responses whenever possible, restricting the use of
weaponry to qualified staff, and eliminating the use of
restraints except when necessary to prevent serious injury
to self or others.
5.	 Employ surveillance technology.  Make good use of
recording surveillance cameras to monitor the correctional
environment.
6.	 Support community and family bonds. Reexamine where
prisons are located and where prisoners are assigned,
encourage visitation, and implement phone call reform.

Provide Health Care that Protects Everyone
1.	 Partner with health providers from the community.
Departments of corrections and health providers from the
community should join together in the common project of
delivering high-quality health care that protects prisoners
and the public.
2.	 Build real partnerships within facilities.  Corrections
administrators and officers must develop collaborative
working relationships with those who provide health care
to prisoners.

3.	 Commit to caring for persons with mental illness.
Legislators and executive branch officials, including
corrections administrators, need to commit adequate
resources to identify and treat mentally ill prisoners and,
simultaneously, to reduce the number of people with
mental illness in prisons and jails.
4.	 Screen, test, and treat for infectious disease. Every U.S.
prison and jail should screen, test, and treat for infectious
diseases under the oversight of public health authorities
and in compliance with national guidelines and ensure
continuity of care upon release.
5.	 End co-payments for medical care.  State legislatures
should revoke existing laws that authorize prisoner copayments for medical care.
6.	 Extend Medicaid and Medicare to eligible prisoners.
Congress should change the Medicaid and Medicare rules
so that correctional facilities can receive federal funds to
help cover the costs of providing health care to eligible
prisoners. Until Congress acts, states should ensure
that benefits are available to people immediately upon
release.

Limit Segregation
1.	 Make segregation a last resort and a more productive
form of confinement, and stop releasing people directly
from segregation to the streets.  Tighten admissions
criteria and safely transition people out of segregation as
soon as possible. And go further: To the extent that safety
allows, give prisoners in segregation opportunities to fully
engage in treatment, work, study, and other productive
activities, and to feel part of a community.
2.	 End conditions of isolation.  Ensure that segregated
prisoners have regular and meaningful human contact
and are free from extreme physical conditions that cause
lasting harm.
3.	 Protect mentally ill prisoners.  Prisoners with a mental
illness that would make them particularly vulnerable
to conditions in segregation must be housed in secure
therapeutic units. Facilities need rigorous screening
and assessment tools to ensure the proper treatment of
prisoners who are both mentally ill and difficult to control.
Continued on page 122
121

commission recommendations (continued)
ii. labor and leadership

III. Oversight and Accountability, continued

Change the Culture and Enhance the Profession

Strengthen Accountability Within the Profession

1.	 Promote a culture of mutual respect.  Create a positive
culture in jails and prisons grounded in an ethic of
respectful behavior and interpersonal communication that
benefits prisoners and staff.
2.	 Recruit and retain a qualified corps of officers.  Enact
changes at the state and local levels to advance the
recruitment and retention of a high quality, diverse
workforce and otherwise further the professionalism of
the workforce.
3.	 Support today’s leaders and cultivate the next gene­
ration. Governors and local executives must hire the
most qualified leaders and support them politically and
professionally, and corrections administrators must, in
turn, use their positions to promote healthy and safe
prisons and jails. Equally important, we must develop
the skills and capacities of middle-level managers,
who play a large role in running safe facilities and are
poised to become the next generation of senior leaders.

1.	 Monitor practice not just policy.  Ensure that American
Correctional Association accreditation more accurately
reflects practice as well as policy.
2.	 Strengthen professional standards. Improve and support
American Correctional Association standards.
3.	 Develop meaningful internal complaint systems.
Corrections managers should strengthen the systems that
allow them to listen to those who live and work in prisons
and jails.

iii. oversight and accountability
Invest in External Oversight
1. Demand independent oversight. Every state should create
an independent agency to monitor prisons and jails.
2. Build national non-governmental oversight.  Create a
national non-governmental organization capable of
inspecting prisons and jails at the invitation of corrections
administrators.
3. Reinvigorate investigation and enforcement.  Expand
the investigation and enforcement activities of the U.S.
Department of Justice and build similar capacity in the
states.
4. Increase access to the courts by reforming the PLRA.
Congress should narrow the scope of the Prison Litigation
Reform Act.

Continued above right

122

Educate and Involve the Public
1.	 Encourage visits to facilities.  Create opportunities for
individual citizens and organized groups, including judges
and lawmakers, to visit facilities.
2.	 Strive for transparency. Ensure media access to facilities,
to prisoners, and to correctional data.

iv. knowledge and data
Measure Safety and Effectiveness
1. Develop nationwide reporting. Federal legislation should
support meaningful data collection, and states and
localities should fully commit to this project.
2. Fund a national effort to learn how prisons and jails can
make a larger contribution to public safety. The federal
government and states should invest in developing
knowledge about the link between safe, well-run
correctional facilities and public safety.
3. Require correctional impact statements.  The federal
government and states should mandate that an impact
statement accompany all proposed legislation that
would change the size, demographics, or other pertinent
characteristics of prison and jail populations.

In March, 2005, we began the first national
prison commission in three decades. At
2.2 million, the prisoner population was
larger than ever and still growing. There
were accumulating doubts about the
effectiveness and morality of our country’s
approach to confinement. Fifteen months
later, the need for reform feels even more
urgent. Millions and millions of lives are
at stake. It is time to do what corrections
officer Lou West tries to do every day: to
make things right.

www.prisoncommission.org