Suicide is the second common cause of death in jails and prisons. The suicide rate, number of suicides per 100,000 inmates, is substantially higher among prisoners compared to general population, with the rate in jails far exceeding the prison rates.
Anasseril E. Daniel shares: “As the mandatory medical and mental health treatment have become common place, the rate of suicide has been on the decline during the last two decades or so.”
Anasseril, a forensic psychiatrist and expert in wrongful deaths and suicide in prisons, discusses more about the issues surrounding malpractice and indifference claims, why it is so commonplace and subsequent litigation which follows such unfortunate cases.
Firstly, can you briefly summarise the most common causes of litigation in correctional institutions.
The most common cause of litigation in correctional settings is the suicide of a detainee or an inmate. Two types of claims are common: 1] malpractice, mostly against healthcare providers, which is often litigated in state courts and 2] 1983 civil rights violation claims which are litigated in Federal Courts. Sometimes, both types of claims can be made simultaneously.
More often than not, inmates who are vulnerable to suicide present known obvious and substantial risk factors for suicide. Failure to assess such risk or take action would be the basis of liability.
What process do you undergo when first instructed on a case? Can you share with Lawyer Monthly your step by step process?
The process depends on whether the litigation is about malpractice and or deliberate indifference claim.
In a malpractice claim, the analysis focusses on whether a health care provider deviated from the standard of care and such negligence had any nexus to the injury or death of the inmate.
Analysis of a deliberate indifference claim is a more complicated process. This may involve a review of the administrative structure, staff organisation, contracts with the providers, policies, and procedures concerning access to medical and mental health care, suicide prevention and monitoring of care and staff training and any other aspect of care. The goal is to determine whether the correctional organisation and the staff, having known the serious medical and mental health needs of an inmate deliberately disregarded such needs, which caused or contributed to the injury or death.
In my experience, a significant number of lawsuits are settled after the discovery and depositions are completed.
Court cases have found that deliberate indifference can be supported when an official knows of a prisoner’s need for medical [or mental health] treatment and intentionally: a) refuses to provide it; b) delays medical treatment based on a non-medical reason; or c) prevents a prisoner from receiving needed or recommended treatment [Innis v. Wilson 334 F. App’x 454, 456 [3RD CIRCUIT 2009]
Failure to assess an inmate’s vulnerability to suicide is a critical factor. More often than not, inmates who are vulnerable to suicide present known obvious and substantial risk factors for suicide. Failure to assess such risk or take action would be the basis of liability. Sometimes, a provider would discontinue the appropriate level of care prematurely, without proper risk assessment, which can be basis of a deliberte indifference claim.
Recently, a Federal Judge opined that in §1983 claims the court consider “a patient’s history of suicidal propensities, decedent’s diagnosis upon detention, suicide rating, and mental health status in determining whether a prison official has acted with deliberate indifference [ Judge Joy Flowers Conti, Western District of Pennsylvania, September 2018]. The court further stated that “while the prison official cannot guarantee that the prisoners will not commit suicide, officials are nevertheless obligated by the fourteenth amendment [to] not act with reckless indifference to an inmate’s vulnerability[,] if that vulnerability is known or should be known by the official.”
Prison officials should make sure that a comprehensive suicide prevention policy and procedure is developed and implemented. Implementation of the policy and procedure is critical.
The expert consultant analyses, not only the specific aspects of care provided to a decedent, but also the overall structure and organisation to determine whether reasonable care was provided to inmates to support or refute such a claim. Upon completing the analysis and review, a well-reasoned and thorough report outlining the expert opinions is prepared and made available to the attorneys. After the report, the consultant may be asked to provide a deposition or present testimony during the trial. In my experience, a significant number of lawsuits are settled after the discovery and depositions are completed.
Regarding suicide in jails: what should prison officials be aware of? In your opinion, what can be done to reduce such cases?
Suicide prevention in a prison is a collaborative responsibility of administrative, medical, mental health and custodial staff. While not all suicides can be prevented, a high degree of suspicion of the potential for suicide by inmates is essential.
Prison officials should make sure that a comprehensive suicide prevention policy and procedure is developed and implemented. Implementation of the policy and procedure is critical. Officials should make sure that not only adequate staff are available for identification, assessment and intervention of all potential suicidal inmates, but also provide the necessary tools to identify and monitor suicidal inmates.
For instance, a suicide screening instrument which queries the common risk factors of suicide at the time of booking should be mandatory. Training of all staff about suicide prevention policy and procedure should be done on a regular basis. Adequate resources to hire mental health staff, particularly psychiatrists, should be made available.
Because the most common method of suicide in jails and prisons is hanging, prison administration should make every effort to eliminate all possible anchors from inmate cells and make them suicide resistant. World Health Organization’s Update of the Resource Guide For Prevention of suicide in Jails and Prisons [2007], of which I am one of the authors, have outlined what the stakeholders could do to minimise the incidence of suicide and suicide attempts.
From a litigation stand point, the emphasis should be to determine what actions and inactions by the prison officials and the health care providers were causatively related to the death of the inmate.
How complicated can these cases get? What do you do when trying to determine the cause of death?
The cause of death of a decedent is generally known, which is usually suicide by hanging. The second most cause of death is drug overdose, mostly by prescription medications.
From a litigation stand point, the emphasis should be to determine what actions and inactions by the prison officials and the health care providers were causatively related to the death of the inmate. The question is: did the prison officials know or should have known the inmate’s vulnerability, and whether reasonable steps, administratively and clinically were taken to prevent the inmate from injuring himself/herself.
In my experience, one of the common failures by the clinical staff is not to adequately consider an inmate’s history of suicide attempt, the single most predictor of future suicide and the impact of dual diagnosis of mental disorders and substance abuse.
Determination of these elements is sometimes difficult due to the problems inherently associated with the setting, because the primary goal of jails and prisons are custody, safety and security of the inmates, not to mention the other goals such as deterrence, retribution and rehabilitation.
Analysis of the causation of death can become very complicated by lack of evidence of communication between clinical and custodial staff and failure by the clinical staff to perform suicide risk assessment and inadequate documentation of custodial supervision and clinical monitoring, although modern technology makes the communication easier.
In my experience, one of the common failures by the clinical staff is not to adequately consider an inmate’s history of suicide attempt, the single most predictor of future suicide and the impact of dual diagnosis of mental disorders and substance abuse.
The internal investigation report or post incident analysis by the jail personnel may provide additional information on causation. The expert consultant reviews every piece of data to arrive at reasonable conclusions which can be supported during deposition or trial testimony.
The Supreme Court and the Federal Courts have laid the legal foundation for appropriate and reasonable medical and mental health care.
Do you think any regulatory changes need to be made to ensure full justice is served post wrongful deaths?
I do not think any regulatory changes are needed now to ensure full justice is served post wrongful death. The Supreme Court and the Federal Courts have laid the legal foundation for appropriate and reasonable medical and mental health care. The National Council of Correctional Health care [NCCHC], American Psychiatric Association, American Psychological Association and American Correctional Association have all set the standards and guidelines for prevention of suicide and wrongful death in jails and prisons.
Anasseril E. Daniel, M. D
DANIEL FORENSIC PSYCHIATRIC SERVICES
33 East Broadway, Suite 115
Columbia, MO 65203
Telephone: (573)443-6930 Fax: (573)875-4272
aedaniel@aol.com
www.danielforensic.com
"I am a forensic psychiatrist with experience and expertise in correctional health care administration and clinical practice. My area of expertise is suicide, and wrongful death in jails and prisons. By research and analysis of risk factors of suicide by detainees and inmates, and developing prevention strategies, I had established considerable expertise in the field. As a consultant, I provide expert opinions and if appropriate medial opinion testimony on matters in dispute such as standard of care, deliberate indifference, and civil rights violations.. I have consulted on at least 45 cases under litigation in the United States and testified in at least 15 cases."
