Incarceration Harms Health: Homer Venters’s Book on Rikers Island Jails

Life and Death in Rikers Island By Homer Venters

Baltimore, MD: Johns Hopkins University Press; 2019 Paperback: 201 pp; $26.95 ISBN-10: 1421427354 ISBN-13: 978-1421427355

Sometime after having read Homer Venters’s compelling Life and Death in Rikers Island we are still astounded, and not solely because of the cruelty, neglect, and inhumane treatment. No, we remain dismayed because of (1) lack of transparency by public agencies; (2) public apathy to these conditions, even when they are made public; and (3) conditions that are tolerated by government agencies in one of the world’s most developed countries, even as New York City authorities and prison officials in other jurisdictions are repeatedly found liable for preventable deaths from neglect, mismanagement, and brutality. And these authorities, as with others throughout the United States, keep many of these issues outside the public eye for political purposes. When they do become public, it is shameful that the broader public conscience is not appalled by the heinous living conditions in jails and prisons. All the more so because it occurs in one of the most so-called progressive cities in the United States.

Homer Venters is the former chief medical officer for the New York City adult jails, including those on Rikers Island. In his role, Venters demonstrated courage and leadership, using data and his medical authority, to raise important questions about the dual loyalty that health practitioners wrestle with in attempting to challenge excessive punitive conditions and practices. Venters is a role model for using data as a tool for both epidemiology and human rights. In his book, he describes rigorous case reviews and epidemiological studies that demonstrate causes of harm.

Although Rikers Island jails house almost 8000 people on an average day, this is less than half of its peak in the 1990s. Alternatives to incarceration and bail reform have been quite successful, especially those tailored to people with a serious mental illness. As a result, New York City has the lowest carceral rate of large cities in the United States. Notwithstanding, Venters describes ongoing inhumane conditions.

REAL CASES AND DETAILED TRAGEDIES

The book focuses on real cases, tragedies detailed in nine insightful chapters, illustrating violence and injury, solitary confinement, serious mental illness, and sexual assault by both incarcerated persons and officers. Furthermore, it details lack of transparency, prison mismanagement, and the negative impact on the health of incarcerated people. Venters portrays the plight of correctional officers, who also are victims, working in degrading conditions with little support.

Notwithstanding the behavior of his custodial colleagues and despite their lack of accountability and transparency, Venters patiently designed studies to provide objective data that should drive change in these jails. His team’s analysis of the effects of solitary confinement, with its dramatic consequences on health, was one of the 2014 AJPH Papers of the Year.¹

As an example, Venters describes a death by self-harm—swallowing highly concentrated soap. Jason Ecchevaria wanted to draw attention to his desperate situation and neglect; he wanted to have contact with humans who cared about those who suffer the harsh conditions of confinement. Security staff refused to let Ecchevaria out of solitary confinement for access to health care, leading to his death. People in neighboring cells heard him scream for help. He vomited blood, bile, and stomach acid and ultimately died with an eroded esophagus. Venters describes this as one of the longest and most painful deaths he has investigated. One can hardly imagine the cruelty of staff to let someone die right in front of them.

According to Venters, analyses of jail tragedies rarely show the dehumanizing infrastructure and mismanagement of the institutions as causal. Instead of focusing on systems issues, he claims, such analyses too often focus blame on individuals, and little effort is made to provide more system transparency and accountability.

SOLITARY CONFINEMENT

Many cases described in the book point to the overuse of solitary confinement at Rikers, which has a devastating negative impact on health and an increased risk of death that persists after release, particularly for those with mental illness and who are younger.^2–4 The death of Kalief Browder, who entered Rikers at age 16 years, tragically illustrates these risks.

The UN Special Rapporteur on torture, Juan E. Méndez, recommended a ban on prolonged or indefinite solitary confinement as punishment or as an extortion technique; he opines that this could amount to torture, especially when used as punishment, during pretrial detention, or for a prolonged period for juveniles or persons with mental disabilities.

According to Venters, there is a need for organizational change, which includes health care. The prison health staff should be independent of the custody staff and affiliated with health authorities, yet they should interact and cooperate effectively (http://bit.ly/2Ohuii0).⁵ Furthermore, care must be overseen by independent entities. In New York City, this has already happened. The New York City Health and Hospitals Corporation provides medical and mental health care, and the New York City Board of Correction provides oversight. Both are independent public agencies, by contrast to private vendors used in other jurisdictions. For 15 years New York City contracted out medical care at Rikers to a private vendor, Corizon. This ended in 2016, when the Health and Hospitals Corporation assumed responsibility for providing care directly by its employees. As a public entity, it is now more difficult to evade accountability.

#CLOSERIKERS

The book leaves no doubt that Rikers creates harm to many and even kills some—the place is rotten and should be closed, as it will be, in large part because of the activism of formerly incarcerated people in efforts such as the #CLOSErikers campaign. But what then? Venters makes constructive suggestions and describes the resistance to building new jails in urban communities. Some people view the proposal to create smaller, more humanely designed jails in the boroughs as acceptable, and others think no new jails should be constructed and Rikers Island should be shuttered—shuttered, with no consideration of the unintended consequences of no jail at all.

According to Venters, Rikers costs $132 019 per capita per year, with even higher real costs, considering the consequences of imprisonment for families, workplaces, and communities. How can this be justified? There is hardly any scientific evidence that imprisonment has positive effects on incarcerated people or the communities to which almost all will return. Harding et al. state, “Imprisonment is an ineffective long-term intervention for violence prevention, as it has, on balance, no rehabilitative or deterrent effects after release.”^6(p671) Furthermore, investment in alternatives to incarceration will likely yield more benefit than does incarceration.

The United Nations’ Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, which has still not been signed by the US government, foresees national prevention mechanisms with the aim of preventing torture and other cruel, inhumane, or degrading treatment or punishment (https://www.ohchr.org). In 1987, the 47 Council of Europe countries took one step further by adopting a convention to prevent torture. In 1989 it created the Committee for the Prevention of Torture, which has extended rights and is enabled to visit every place of detention at any time in every member country (https://www.coe.int/en/web/cpt/home).

HARMFUL INSTITUTIONS

Venters concludes, “American jails are horribly run institutions. By design and by incompetence, jails create the risk of death, injury, and illness for the incarcerated” (p. 135). These are strong statements, backed up with depictions of mainly young, vulnerable patients who died in custody or shortly thereafter. This is most astonishing in the face of a decade of public pressure led by formerly incarcerated people to reduce imprisonment in New York City.

Former Chief Justice Warren E. Burger (1907–1995) wrote, “To put people behind walls and bars and do little or nothing to change them is to win a battle, but lose a war. It is wrong. It is expensive. It is stupid.”^7(p439) Venters’s book impressively demonstrates that too little has been done at Rikers to prevent suffering, violence, and death.