Dr. Bill Wright on another way to run a prison

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I have previously written about Doc Wright, and his fabulous book Maximum Insecurity. Dr. Wright has written a new book that I hope to review soon. Jailhouse Doc is a memoir of his time as Medical Director of the El Paso Criminal Justice Center in Colorado Springs.

“Hoards of desperate people fresh from the streets, homeless addicts, illegal aliens, and gangbangers all ruled by a corrupt sheriff and his concubine sidekick made the supermax look almost pastoral. Told with humor and biting wit by the best-selling author of Maximum Insecurity, Jailhouse Doc follows Dr. Wright and his struggles with scamming inmates, corporate bureaucrats, and a sheriff who wants to be a doctor.”

For now, I am privileged to post Chapter 30 of Jailhouse Doc.* If  you care about prisons and inmates and money and crime and recidivism and humanity, you will be interested in Wright’s serious observations about another way to run a prison:

 

Chapter 30 – Philosophy: Enter at Your Own Risk

America is the land of the second chance—and when the gates of the prison open, the path ahead should lead to a better life.” – George W. Bush

In my country we go to prison first and then become President.” – Nelson Mandela

 

After nine years at this game of correctional medicine, I’ve got some thoughts on jails, prisons and in particular our system in the U.S. We’ve got lots of agendas when it comes to putting people behind bars, and not all of them seem very productive.

The first thing to remember is that most people in jails and prisons get out. They’re your neighbors again, working (or not) in your community around you, your spouse, and your children.

It’s a sad fact that the majority of people released from U.S. jails and prisons commit further offenses and head back behind bars again to repeat the cycle. What’s wrong with these guys? Didn’t they learn their lesson the first time?

Well, they did. They just learned the wrong lesson.

When someone commits a crime against another person, there’s a lot of emotion on both sides. What we want is for everything to be put back the way it was, like nothing ever happened. In this world, that’s not going to happen.

As the next best thing, society wants punishment of some kind. Just like when we were children, if we did something wrong and were punished, we’d learn to not do that again.

It seems reasonable, but it makes a lot of assumptions.

It assumes we’re in an environment where we have a model for better behavior and encouragement to follow that model. Jail isn’t famous for being a nurturing and supportive environment. Mom and Dad aren’t here, but Professor Butch and Professor Bubba are. Guess what the lesson today is. Breaking and Entering 102 or maybe Sexual Predation 203. Most inmates don’t learn new skills in jail; they learn new hustles.

So what do we do with thieves, rapists, and murderers? We might take a look at the Swedish model.

At over 700 imprisoned per 100,000, the United States leads the world in incarcerating its citizens. That’s like locking up the entire population of Houston, Texas, the fourth-largest city in the U.S. It’s more than ten times the rate in Sweden. The incarceration rate, while climbing in the U.S., is falling in Sweden, down a whopping 6 percent last year. Are we missing something?

If you look at prisons in Scandinavia, like Skien maximum security prison in Sweden or the island prison of Bastoy in Norway, we see a very different physical setup from supermax prisons in the U.S.

In Colorado’s maximum security prison, Colorado State Penitentiary (CSP), inmates are confined 23/7 to individual cells with steel bunk, desk, stool and toilet. A solid steel door with a tray slot for passing medication and food is the only contact a prisoner has with the outside. Exercise is also solitary in a spare room with a chin-up bar as the only furnishing.

In Sweden, their prison rooms look like a Motel 6 with TV, computers, bookshelves, rugs on the floor, curtains at the windows and separate areas for reading and recreation. The prisoners, with some exceptions, aren’t isolated, but are part of a community where each has a job with responsibilities and free time. They live in small, brightly painted wooden bungalows that accommodate up to six people.

Every man has his own room, and they share kitchen and other facilities. The idea is to get them used to the social situation they’ll encounter when they’re released. They earn about $10 per day and get a food allowance of about $120 per month. They fix their own breakfasts and dinners from items available in the prison’s supermarket.

For these prisoners, loss of freedom is their only punishment. Administration puts emphasis on cultivating individual responsibility and functioning in a community environment. Recidivism is about 30 percent in Sweden and only 16 percent for those released from Norway’s Bastoy prison, versus 65-70 percent in the U.S.

Bastoy’s governor, Arne Nilsen, a clinical psychologist by profession, makes a point: “In the law, being sent to prison has nothing to do with putting you in a terrible prison to make you suffer. The punishment is that you lose your freedom. If we treat people like animals when they are in prison, they are likely to behave like animals when released.”

Granted when I went to work at CJC I’d already had years of experience in corrections, but many start the job with zero corrections knowledge. In contrast, Norway requires three years of training to become a prison guard.

So is treating prisoners like human beings rather than people who should be shunned the secret to the Scandinavian success? That’s certainly part of it.

A second feature is placing greater emphasis on reaching young people at risk for trouble before they get into the formal justice system. It’s a compelling fact that 80 percent of death row inmates in the U.S. are products of the juvenile justice system.

Maybe these men could have been rehabilitated if reached early enough in their lives or if they were taught a different way when they started down the slippery slope of antisocial behavior. I don’t know if this is true, but it’s something we should think about in view of the Swedish model’s superior results.

Although it’s expensive to spend on preventive measures like education and social work to intervene in bad situations, it’s more expensive to let the problems develop. One estimate claims that $1 spent in prevention saves $17 in later costs of property loss and incarceration, let alone personal misery. Like the old oil filter commercial said, you can pay me now, or you can pay me later.

Regardless of one’s outlook on punishment, I think we can all agree that the best outcome of any crime is if it never happens. I’m way out of my depth proposing sweeping social change, but I think we need to rethink our concept of imprisonment. Is vengeance better than rehabilitation?

Any crime is horrible for the victim. The desire to lock up the perpetrator and throw away the key is strong. Society has a different stake. Most of the offenders are going to be out again, and we have an interest to prevent additional offenses.

Is loss of freedom enough of a punishment? Having worked around that atmosphere for nine years, I can vouch that loss of freedom is a major deal. If we could make the time in jail or prison actually productive for the offender, maybe it will be productive for us as well. Maybe treating criminals like human beings is an idea whose time has come.

Please tell me what you think.

RGK

*Doctor Wright has given me a one-time license to publish Chapter 30. He retains the copyright. No republication of Chapter 30 is permitted without Dr. Wright’s express written permission.

“Maximum Insecurity”

Above all else, I suppose this blog seeks to promote transparency about what it is like to be a federal trial judge. In a recent letter, William Wright, M.D., after coming across this blog in a USA Today piece about my Hobby Lobby post, thought I might be interested in his effort at transparency. But before I get to that, a little background about Dr. Wright is in order.

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William Wright, M.D. is a graduate of the University of Michigan Medical School. He practiced surgery of the ear for 30 years before attempting (unsuccessfully) to retire from medicine and spend time with his wife, an artist, and an assortment of furry friends. A private pilot, he is also the holder of three black belts and instructor certifications in Tae Kwon Do and Aikido. He is a talented digital artist fascinated by motion, energy and light. And, if all that were not enough, he is one helluva of a writer.

His book Maximum Insecurity: A Doctor in the Supermax chronicles eights years practicing general medicine at Colorado’s maximum security prison after Wright found that retirement from medicine was driving him (and possibly his wife) nuts.* The book is wonderful.

It is hysterically funny, insightful, and very human. Most of all it provides a transparent, but worldly, glimpse into the practice of medicine in a prison where the patient population consists of especially serious (and often loopy) offenders, where the prison bureaucracy strives mightily to act as dysfunctional as the screwiest of inmates, and where the physicians, assistants and nurses undertake to treat with compassion, but not judge, or burst out loud laughing at the machinations of, an odd and sometimes dangerous lot. It was “Runner Up” in the General Non Fiction category at the 2014 Hollywood Book Festival.

Keeping in mind what Wright had no reason to know when he wrote me, that is, I manage our docket of prisoner cases and thus have read a ton of complaints of inadequate medical care in prison, here are a few snippets from the book:

  • Wright explains his first few days as a prison doctor and the fact that his straight chair would not allow him to fit his legs under his desk. The solution? A new adjustable chair. Oh, no. The helpful maintenance staff cut a 2×4 into four pieces and put the four desk legs on the four shortened pieces of lumber. Desk raised four inches. Problem fixed!
  • He explains the “secret” e-mails he receives from the administration in Denver that are urgent but can never be opened because they require a unique password that he cannot get because that special password requires a second special password that he is prohibited from accessing.
  • While performing a routine check up on a murder who had killed five people in a fast-food restaurant, Wright details how the correctional staff inched forward ready for any violence as the doctor began the examination of his patient. Wright touched a stethoscope to the patient’s chest fearing that “might be like lighting a dynamite fuse.” With that, a “a sly grin” came across the man’s face “spreading his thin lips.” “You scared, ain’t you doc? You should be. I be the baddest man you ever see.”  Despite his martial arts training, Wright was scared. “What the hell was I doing here?”
  • And the drug seeking behavior. The doctor explains how one of his patients, “a chop shop entrepreneur from Fort Collins,” came to the clinic because of a complaint about pain in the heel of his foot. Trying to remember the name of the powerful painkiller “Percocet” that the inmate was seeking, but being unable to do so, Wright sees the inmate “thinking hard.” Wright wryly observes, “This is a huge red flag.” Why? Because “[w]henever an inmate is trying to think he is lying.” After the doctor suggests the name of the highly addictive pain-killer, the patient’s eyes light up in relief. The inmate-patient tells the doc he only needs a supply of Percocet for “[j]ust a few months.” Tartly, the doctor responds, “No. Use the heel pad. Have a good day.”
  • This gentle soul describes his treatment of a kid who escaped from a county jail, fell forty feet, and impaled his abdomen on a steel post. Because the nerves were impaired and needed to heal, the bowels were pulled out of the mid-section in a procedure called an ileostomy. After two years of treatment, the nerves recovered and it was time to put the bowels back where they belonged. It was only then Wright learned that as a matter of policy they “don’t reverse ileostomies.” Flabbergasted and frustrated, Wright concludes: “Maybe someone should have thought of that a couple of years ago. But I’m just the hired help.”

Near the end of the book, in a passage I liked the most (p. 240), Wright writes more broadly and warmly of his patients and his oath as a physician. He is (to put it mildly) “less sanguine” about working in a bureaucracy even though there are “stars that shine” in “supervisory roles.” “They shine against a dark background.”

He remembers taking the Hippocratic Oath at the University of Michigan, his “throat tight with emotion.” “It is a pledge to always act in the best interests of my patients.” To Wright, that was “not a quaint ritual.” He still carries “every syllable into the clinic with” him. “[T]he examination room is not the place for moral judgments.” “Even sociopaths cry in the night[,]” “[m]urders miss their children[,]” and child “molesters feel shame.”

When one of his patients remarks, “You really take this serious, don’t you, Doc[,]” Wright is almost surprised. Reflecting, the good doctor concludes: “I do. Perhaps my patient doesn’t deserve the best I can offer, but for my sake I can give no less.” (Emphasis added by Kopf.) And, that is a good place to end.

RGK

*Even with my cancer treatment and my whiny complaints, Joan, my wife, tells me that I can’t retire because, as she puts it, “I married you for life, but not for lunch.” Despite my hang-dog expression, she never smiles when she repeats this mantra. Just like the lymphoma, she is deadly damn serious. As is often the case, she is right.

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