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Authors: Ms. Mary E. Buser

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30

The day after my visit to the dorm, I presented the names of the predators during our clinical meeting. After a perusal of their charts, it was agreed that they were all fit for discharge to the AMKC general population. “Let them try to pull that fire stunt in GP,” Karen asserted.

Though our decision was swift, the real question was whether or not we could keep them from returning. Virtually every time we discharged malingerers, the following morning their names popped right back up on our census. The problem was the new overnight doctors, the moonlighters. With no connection to the larger organization, they ignored logbook directives, and when discharged malingerers threatened suicide in the middle of the night, these doctors simply readmitted them. When questioned, their defense was that suicide risk put their licenses on the line. Although this sounded plausible, there was no true threat of suicide, which they would have realized had they been part of the larger staff working daily in the Mental Health Center with one biweekly overnight shift, which had been the arrangement in the past. But these doctors simply finished up and left for the week. With this gaping hole in our overnight defenses, the stage was set for infiltration by the worst brand of malingerers, those who preyed upon the weak. And in they came. Fights became daily occurrences, slashings commonplace, and extortion of the weak and sick was rampant. A steady flow of patients with gashes, broken bones, and bloody noses
streamed through Hart's Island to be stitched and bandaged or, worse, wheeled out on gurneys.

One afternoon on a trip to Hart's Island, I heard a low, sickening moan. Alone and pushed to the side, a disheveled inmate lay on a gurney, writhing in pain.

“What happened to him?” I asked a nurse.

“The bone around his eye was shattered—very painful,” she said. “We're just waiting for the ambulance.”

One of the two COs sitting watch chimed in. “He didn't pay rent.”

“He didn't pay
rent?

“That's right—didn't pay rent. They jumped him and broke his face to make an example out of him.”

I felt sick. Without even looking at this inmate's chart, I knew he was mentally ill, that he rightfully belonged in the Mental Health Center, yet in this “protected house” he'd been brutally attacked. He'd have been better off in GP.

Alarmed by the violence, captains and deps descended upon George's office, imploring him to keep the predators out. Things got so bad that DOC informed us that the Mental Health Center, which held only 350 of AMKC's 2,500 inmates, was responsible for 75 percent of the jail's violence. Since we had sole authority as to the Mental Health Center's occupants, our inability to handle the situation was as demoralizing as it was embarrassing.

Since George had one foot out the door, he was disinclined to push the matter with Central Office, and even when he had tried, he was told that the recruitment of fully licensed doctors was a contractual obligation. Our new employers simply had little understanding of their unique domain.

But if I held out a single hope that this whole mess could be salvaged, it rested on George's departure. On a brisk November morning, George informed me he'd nailed down another job. With our leadership limbo ending, I looked forward to what the next chief might offer. With a little luck, we'd get a competent leader with experience and vision, someone who could forcefully communicate
with Central Office, contractual obligations or no. Since George was giving a month's notice, I only hoped there was enough time to interview a battery of candidates before his final day. Some speculated there might even be a nationwide search to find the right person for this unique post.

But none of this was to be. George announced his resignation on a Monday, and by Tuesday a decision was made. Evidently skipping over any customary interview process, Suzanne Harris handpicked a newly hired St. Barnabas clinician to take over, someone with less than a year's experience at Rikers.

The stunning news was met with outrage. Not only were solid administrators with years of management experience passed over, they weren't even given an opportunity to apply for what was considered the crown jewel position. After this insult, there was loud talk of labor law violations, while everyone vowed to step up their job-seeking efforts and quit.

For me, this move was as disturbing as it was disappointing. With a relatively inexperienced person at the helm, nothing would change; in fact, it seemed likely that things would get worse. On the heels of George's farewell party, I contemplated a move to another jail.

But as luck would have it, there were no open positions on the island. I had to bide my time—and in the interim, run from one crisis to the next, often literally. Whether it was the arrival of a celebrity inmate, uncovered shifts, violence on the units, anxiety over audits, or bickering among staff, calamity was the norm. One morning, I arrived at work to find a rush of correctional personnel running in and out of Hart's Island. I found out why when I stepped inside. The medical side of the clinic had been trashed: desks upended, file cabinets on their sides, papers strewn ankle deep. One of the holding pens' Plexiglas walls was lying on the floor amid the debris. It looked as though a tornado had whipped through Hart's Island. A sea of officers were surveying the damage, including Captain Sikorski and Officer Putney.

“What happened?” I asked.

“They sent somebody over from the Bing last night,” said Sikorski, “and when the psych told him there was nothing wrong with him—that he was going back—he went ballistic.”

Since the Mental Health Center was the only facility that operated twenty-four hours a day, it was common for inmates held in solitary confinement to be bused over for evaluation if they threatened suicide during the night. While some were admitted for brief periods, most were diagnosed as malingering and sent right back.

“Whatever Bing time this guy was looking at before, he's looking at a lot more time now,” commented Putney, referring to the tickets this inmate would incur for the tirade. “They gotta get a policy that these Bing monsters stay cuffed while they're being evaluated. They're the baddest of the bad—the worst of the worst.”

“Bing monster” was the familiar term for inmates in solitary who resorted to desperate measures to get out. While their frantic attempts at relief rendered them a nuisance, Dr. Gardiner continually reminded us that their desperation only demonstrated the grueling nature of solitary confinement.

* * *

By April, I had been at the Mental Health Center for close to a year and I was miserable. In figuring the census, filling shifts, and calculating the payroll, I felt like nothing more than a well-educated clerk. Any type of meaningful management I'd hoped for had fallen by the wayside. But relief finally came when I received a call from a unit chief named Kelly Gordon. Since I only knew her casually, I was surprised when she asked if I'd be interested in joining her as assistant chief at the Otis Bantum Correctional Center, another of the men's jails. “It's pretty nice over here, as far as jails go,” she said. “I'm trying to build a new team and I need an assistant chief. I think you and I could work well together.”

I thanked her but didn't take the offer seriously. We had just learned that our new chief was pregnant, and I would be relied on
to take over during her maternity leave. “There's no way they're going to let me go,” I told her.

“I think this could really be great,” she persisted. “It's a smaller building—1,600 inmates—and we actually have an adequate number of staff. I think it could be really good.”

What she described was appealing, but the conversation was pointless, and when we hung up I gave it no further thought.

On a sunny day about a week later, I decided to weather all the time-consuming security checkpoints and go off the island for lunch. I drove down to the river and found a quiet spot near the Triboro Bridge. It felt nice to take in the open sky and wide expanse of the East River. With the lazy jangle of an ice cream truck in the distance, I watched as tugboats pulling tankers from around the world steamed into New York Harbor. I was just finishing up when my beeper went off. It was Central Office. I called in and was instructed to report to Suzanne Harris's office.

Hugh Kemper, third in command, greeted me. A diminutive man with a crinkly smile, Hugh was generally well liked. He ushered me into Harris's office, where the deputy director was lighting up a cigarette. A team picture of the Yankees smiled down from above.

Hugh cleared his throat and started, “Mary, as you know, we've been moving people around, trying to get the right fit for each jail—”

“Because,” Suzanne interrupted, “each jail has its very own personality!”

“Yes,” continued Hugh, “and we're trying to put the right managers into the right buildings. And we've decided that you would do well at OBCC. In fact, Kelly Gordon has specifically requested you as her assistant chief.”

“Which is really quite flattering, Mary,” Suzanne threw in.

I was stunned. They knew there was an upcoming maternity leave. I was familiar with the Mental Health Center's operations, I knew the staff, and I'd developed a decent rapport with DOC. None of this had happened overnight. I couldn't imagine how they
were going to just throw someone else in here to learn all of this so quickly.

“Kelly needs you as soon as possible,” Suzanne continued, “so as of Monday, you'll report to OBCC.”

For a moment I struggled to figure it out, trying to understand their logic. And then it dawned on me that I didn't need to understand. All that mattered was that I was leaving a job I disliked, and this time their zany reasoning was working in my favor. Just like that, the Mental Health Center fiasco was over. Maybe things would be different at OBCC. It was a smaller jail and didn't have the high profile of the Mental Health Center. A smaller staff meant less time devoted to administrative tasks and more time for meaningful management. This was the break I'd been hoping for, and once again I found myself getting excited about my work. But as enthusiastic as I was, something was gnawing at me: within the confines of the Otis Bantum Correctional Center was the Central Punitive Segregation Unit—the Bing.

31

I spent my last morning at the Mental Health Center clearing out my desk and saying hasty good-byes. At noon, Kelly Gordon picked me up and we drove off the island for lunch at a local Chinese restaurant. Though small in stature, Kelly was an administrative dynamo. “We have a great staff,” she said excitedly. “The last chief quit so the place has been in limbo. It'll be up to us to rebuild and get things stabilized. We don't have a clinical supervisor yet, but Hugh Kemper is interviewing for one now, so when that spot's filled, we'll be in good shape. Hugh is our liaison with Central Office, and we're lucky—he's okay. At least we're not stuck with Yankee Doodle Dandy!”

With that, we both smiled and then started laughing. But when the laughter subsided, Kelly fell silent, and in a measured tone, she said, “Mary, there's something I should probably tell you.”

This had the same ring to it as George's announcement when I arrived at the Mental Health Center. “Let me guess. You're quitting?”

“Well, not right away,” she stammered. “I mean, I'm hoping things will work out, but if something else comes up, I'm out of here. Everyone's trying to get out—you ought to think about it too.”

I just sighed. We drove back in silence.

But as we pulled up to the Otis Bantum Correctional Center, my spirits picked up. The relatively modern building was bordered
by a neatly manicured lawn, and just down the hill the East River sparkled. I had a good feeling about this place. Maybe this was the new beginning I was searching for.

The lobby held the requisite pictures of Mayor Giuliani, Bernard Kerik—newly installed as correction commissioner—and Otis Bantum, the jail's namesake, a popular former warden. A couple of “trophy cases” showcased dozens of confiscated weapons. Made from odd scraps of metal sharpened to a razor's edge, some were long and pointy, resembling ice picks, while others were small and compact. The weapons were crude but deadly, a reminder that as nice as OBCC appeared, it was still jail.

Just inside the entryway gate, a picture window revealed an interior courtyard where inmates played basketball. Except for the watchful presence of correction officers, it could have been any city playground.

Kelly steered me to the clinic, where nurses in colorful uniforms that always reminded me of pajamas moved in and out of examining booths, loaded down with stacks of charts. In the center aisle, a row of hapless detainees awaited treatment. Keeping an eye on them was the clinic traffic cop, Officer Pepitone. Another gruff CO, he was on the phone, barking orders to an officer in an outer waiting room. “Send in three more bodies . . . no more than three!”

The clinic captain, standing next to Pepitone, fumbled with a hand-held radio. Two blue chevron patches stitched to the sleeve of his white shirt indicated at least ten years with the department. A chunky man in his late thirties, Captain Ryan put the radio down, and with a ruddy smile pumped my hand. “Welcome to OBCC!”

“He seems kind of nice,” I said to Kelly, as we stepped away.

“He is—and everybody here likes him.”

At the rear of the clinic, an inner recess led to our office, where I met Dr. Ismael Sackett, the chief physician. Wiry and nervous, he shook my hand with an iron grip and informed me he wouldn't be chief much longer, that he was just waiting on his “demotion.” As a creative alternative to quitting, administrators distrustful of
the new regime were lining up for demotions, seeking safety in the union ranks.

The Mental Health office was clean and comfortable, the cinder-block walls painted a soft blue. Around the perimeter of the rectangular room were three desks: one for Kelly, another for me, and a third for our eventual clinical supervisor.

Out in the clinic, Pepitone shouted the start of the afternoon count, and a few minutes later, the Mental Health crew meandered in, and it was with high hopes that I met our staff. Theresa Alvarez and Kathy Blakely, two recently hired young clinicians still fresh with ideals inculcated in school, were eager for managerial stability and support. Lynn Cosgrove, a longtime Montefiore veteran, was older and a bit jaded, but still friendly and receptive. Pete Majors was another clinician from the Montefiore days; he and I knew each other from GMDC, where he'd worked the night shift. Dr. David Diaz, a psychiatrist, was a hefty man in his early fifties who worked exclusively in the Bing. Originally from South America, his ability to flick into his native Spanish was a huge asset in treating the jail's large Spanish-speaking population. Another psychiatrist, Dr. Christian, was warm and chatty.

We pulled up chairs and, over the next hour, discussed our future work together. As ideas and suggestions were tossed about, it was with a sense of camaraderie and goodwill. An evening meeting with the night staff was equally encouraging. When we locked up the office for the day, I felt that this was it, that I'd finally found the team I was looking for.

* * *

Over the next few days, I became acquainted with the jail, starting off with its Mental Observation Unit, a single fifty-bed dorm. “We've got no cells here,” Kelly said, “so if we get a paranoid schizophrenic who needs a cell, we have to send him to an MO in another jail.”

Conveniently located across the hall from the clinic, the Mental Observation Unit was airy and spacious. An abundance of natural
light streaming through the mesh-covered windows lent a mellowness to an otherwise depressing scene. Even the cigarette smoke wasn't as thick here. With the warmer weather, the windows were open, allowing a gentle breeze to flow across the rows of cots where the patients were reading, writing, or dozing. Toward the rear, a suicide prevention aide was engrossed in his paperback.

“It's calm in here,” I noted. “Where's the gang? Where are the malingerers?”

“In general population!” Kelly asserted. “This dorm is for the mentally ill only—and I intend to keep it that way!”

“Good!”

In the dayroom, older men played cards while the usual bunch sat around the TV watching a kung fu movie, a jailhouse favorite.

Perched on the edge of a suicide observation cot, an older man with a trim build and closely cropped white hair smoked a cigarette. Behind his dark glasses, his right eye was distorted. “His name's Roy Evans, and he's one of those murder-suicide deals,” Kelly whispered discreetly. “He's here for major depression.” Roy Evans had apparently shot and killed his wife, but the bullet to his own head did little more than mildly affect his speech, disfigure his face, and put him in jail for murder. He nodded at me but did not smile.

Next to Evans, Teddy Gibson smiled shyly. Barely out of his teens, he was lying on his cot, jiggling his legs to the tune on his Walkman. Gibson's forearms were covered with pink crisscross scars. Kelly told me he was highly impulsive and that, after suffering chronic sexual abuse as a child, the undercarriage of his personality was so fragile that the slightest negative nuance sent him into a self-destructive tirade, as his cut-up arms attested.

As we toured the dorm, we'd acquired a quiet tag-along in the form of George LaRoche, who spoke like someone who was well educated. Wearing canary-colored sweat pants that draped from his thin frame, he became our unofficial guide. Ushering us up and down the rows of cots, he introduced me to Victor, a plump thirtyish fellow in a New York Mets baseball cap and a pair of oversized,
jail-issued eyeglasses. When Victor looked up, his eyes went off in different directions. Mentally limited, he'd emptied out a bag of potato chips on a patch of smoothed bedding. “I don't think they gave me the right amount,” he explained. As he lined up the chips, he told me about himself. “My mom got shot in the belly when she was pregnant with me. The bullet went right through my head. Yeah—that's what happened. Well, I have to count my chips now. Bye.”

Kelly said that Victor had been arrested on a drug charge, either as a lookout during a drug deal or as an unsuspecting courier. It wasn't unusual for drug dealers to exploit those with limited mental faculties for various low-level tasks.

George steered us to Ruben, another pal of his with a Jamaican accent. Ruben jumped up to show off his inside-out jacket, its Ralph Lauren label barely clinging to the collar. “You see this?” he said, twirling around. “When I'm here, I wear it like this. But when I go to court,” he said, removing the garment, turning it right side out and slipping into it, “I'm all ready for the judge.”

“Very nice!” I applauded.

“He even wears that jacket to sleep,” chirped the patient next to him.

In any other setting, I would have attributed this jacket routine to an eccentric aspect of Ruben's mental illness, but in here, I had to admit it was a creative solution to the problem of holding on to one's court clothes.

Off to the side were two small interview rooms cluttered with old furniture. “I don't know how they got to be so junked up,” said Kelly, “but they need to be cleaned out so we can use them for sessions—if for no other reason than confidentiality. Right now, the sessions are taking place in the corners of the dorm—no good!”

Kelly also mentioned that group therapy had fallen by the wayside, and patients were only being seen individually. We agreed that we needed to get therapeutic groups back up and running as quickly as possible.

On our way out, we stopped by the bubble to visit the MO officers, a big, sandy-haired CO and his smaller, freckle-faced sidekick. Not exactly hard-nosed officers, Hartman and Burns came off more like a Laurel and Hardy comedy act.

“Welcome to the nuthouse!” Hartman grinned.

Burns, with one hand tickling the top of his head, and the other patting his stomach, hopped around the bubble. “Hooh, hooh, hooh.”

“Meet our steady officers,” Kelly said wryly.

“Sooo,” said Hartman, “you just met a few of our nuts?”

“I prefer to think of them as our
patients,
” I countered.

“You say
potahto
—we say potato!” joked Burns, with Hartman slapping his knee in laughter.

Although their sentiments were no surprise—the same as their correctional brethren—these two were essentially good-hearted and well-meaning, a very good sign for us.

As we departed the dorm, I figured managing these fifty beds would be a breeze compared to the 350-bed Mental Health Center. Of course, the tradeoff was that I'd be administering services to general population. And then, of course, there was the matter of the Bing.

I was anxious to finally see the infamous jail within jail, and after a meeting was coordinated with the punitive unit's newly installed deputy warden, Kelly and I set out for the five-story tower, which was structurally attached to OBCC.

“I'm glad we're meeting with him,” said Kelly. “It's really important that we have a good relationship with the dep. I hate to tell you this, Mary, but our biggest challenge in here isn't the mentally ill or the guys in GP. Far and away, it's the Bing. Those five hundred cells are always full, and most of these guys are on psych meds—for hallucinating, crying, talking to themselves, defecating, refusing to eat.”

“That bad?”

“I'm afraid so. All four of our psychiatrists carry heavy Bing caseloads. Thank God for the meds. But even with them, a lot of
times they reach a point where they can't hang on anymore, especially if they have long solitary sentences. They get to the end of their rope and start banging their heads, cutting their arms, and trying to hang themselves.”

“And then what?” I asked uneasily.

“Well, obviously, we try to calm them down, talk to them, maybe change the meds. But if we think somebody's really going to die, then we pull him out and send him over to MHAUII.”

“Sounds like a tropical island.”

“Yeah, hardly. More like ‘Mental Health Assessment Unit for Infracted Inmates.' Sort of an MO for Bing inmates. All it really is is eight cells in another one of the jails, but it's smaller and closely monitored by Mental Health staff. It gives them a little relief. But once they're better, they're bused right back here to finish the sentence. We're under a lot of pressure to keep them in, though, because once we send one out, they all start threatening suicide. On the other hand, we can't have anyone dying. It gets tricky—you'll see.”

I got the feeling there was a lot I was going to see that I might have preferred not to.

At the end of a long corridor, a lone officer sat in an elevated Plexiglas booth. Heavy black lettering along the wall spelled out the words
central punitive segregation unit.
We held up our ID badges and the officer inspected them closely. He nodded and the heavy black gate started moving open on its track. We stepped inside, turned a quick corner, and came to an elevator bank.

“They connect to the higher floors,” Kelly explained. “We have a few minutes before our meeting, so let's peek in at the first floor.”

Kelly rapped on a long tinted window positioned between two plain doors. “The door on the left is 1 South,” she said. “The one on the right is 1 Southwest—fifty cells on each side. It's the same layout on all five floors.” A CO thrust out a logbook and we signed in. Kelly told the officer that we wanted to go into 1
Southwest. A loud buzz followed, and we pulled open the door on the right.

Cavernous and dimly lit, 1 Southwest was nothing more than rows of sulfur-colored steel doors, one after the next. At the top were little windows, and on the bottom a narrow flap for food trays. The windows were all empty. “They may look empty,” Kelly whispered, “but it's full capacity in here—they're still sleeping. This is the only time it's quiet in here—the only time there's peace. They're in these cells twenty-three hours a day—no TV, no radio. They're entitled to one hour of rec, but most don't bother with it. They've got to be cuffed, shackled, and taken to an outside cage to stand alone and ‘recreate.' It's a joke.”

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