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Authors: Ms. Mary E. Buser

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Along the walls, cameras were conspicuously mounted. All Bing activity was carefully monitored, the fallout from a class action suit brought against the city for brutality in the punitive unit when it was located in the House of Detention for Men, the original Rikers jail. Among other horrors, Bing officers had routinely inflicted “welcome beatings” as inmates arrived to serve their sentences. Reports of fractured skulls and perforated eardrums were rampant. As a result, the punitive unit in the old, decrepit jail was shut down and the infracted were transferred to this modern tower, where all activity was monitored by camera.

A set of stairs led down to a processing desk and shower area. At an empty shower stall, Kelly made a glum announcement. “
This
—is the Mental Health Office.”

“A shower stall?”

“Yup. Pretty pathetic, huh? Up until recently, we've been seeing these inmates by going from cell to cell and talking through the doors, but Legal Aid's complaining that yelling through doors violates confidentiality. And they're right, but it's not an easy fix. So, the solution DOC came up with is to give us an escort to take these guys out of their cells and bring them down here for privacy. Problem is, we're not always getting this escort. That's what I want to bring up with the dep. Then maybe I can work on getting us a real office in here.”

Kelly looked at her watch. “Let's go.” We departed the eerie 1 Southwest, ducked into a side stairwell, and walked up to the second floor to the dep's office.

I don't know what I expected of someone in charge of a punitive segregation unit, but I definitely didn't expect the warm and friendly deputy warden Alfred Mancuso. Seated behind mountains of paperwork, a trail of cigarette smoke curling up from his ashtray, Dep Mancuso jumped up to shake our hands. “Hello!” he smiled. In his mid-forties, he was of medium build, sported a dark crew cut, and was well educated, as his framed master's diploma attested. Beside the diploma were citations, certificates, and ribboned medals for completed marathons; Mancuso was a dedicated runner. On the wall adjacent to his desk, five long rows of TV screens captured the activities on each floor of the Bing.

Pushing papers aside, he issued directives to a couple of captains who'd followed us in and motioned for us to sit down. “So, Mary,” he said after we were introduced, “what do you think of the CPSU so far?”

“Kind of quiet,” I replied.

“Quiet! Hah! It's still early. As soon as the meals start, the mayhem begins. Just as soon as we unlock the slots to put food trays through, out come the arms—swiping, hitting, grabbing. And lately it's been really bad. They all know I'm new here, so I'm being tested. We're getting a big increase in use of force. At the beginning I expect it, but once these guys see I'm consistent and mean what I say, the numbers should come down. That's what usually happens when there's a change of guard—least that's what I'm hoping. I've been with the department for close to twenty years, and nothing prepares you for this. But there's no getting around this post if you want to become a full warden. You first have to prove yourself in the Bing. Let's see if I survive it,” he smiled.

He paused as a scene on a monitor caught his attention. His eyes narrowed and he dragged hard on his cigarette, watching as a handcuffed inmate was led out of his cell. Satisfied with how it was being handled, he returned to us. “Okay, where were we?”

“Well,” said Kelly, “our immediate problem concerns confidentiality.” She outlined our dilemma and explained that the warden had promised us an escort. “The thing is, the escort isn't always showing up.”

“Well, now, I can see how the cell-to-cell arrangement would work well for the department. It's a hassle to pull these guys out—they've got to be searched, cuffed . . . but if the warden's made that commitment, then I guess that's how it's got to be.” He thought for a moment and said, “How's this: I'll make sure you get an escort every morning. If nobody shows up, call me immediately.”

“That's great,” Kelly said with a note of relief.

“Happy to help. After all, it's the psych meds that make this place even slightly manageable. Plus, I'd really, really like to avoid suicides. So, if you have any issues in here—anything at all—my door is always open.”

“Thank you,” we said.

With business concluded, Mancuso dared us to sample some of the hot peppers he kept in colorful jars on his desk and told us a couple of corny jokes. As we laughed, I was uncomfortably aware that just outside his office, hundreds of human beings were awakening to another day of grim isolation.

32

Shortly after my arrival at OBCC, Kelly took a weeklong vacation, leaving me to run things alone. Given my administrative experience at the Mental Health Center, I felt okay with it, and things started off smoothly. The office coffeepot was the early morning gathering place, and I enjoyed chatting with the crew before the day began. Theresa and Kathy prepared to assess the morning GP referrals while Lynn Cosgrove, wearing a taboo Montefiore lab coat, would start off on the MO. While we sipped coffee, Dr. Diaz, keeping one ear attuned to the early morning chatter, puttered with the plants that sat atop the file cabinets. Pete Majors, the primary Bing clinician, had the longest commute, and he and Dr. Christian were the last ones to rush in and join us before things got under way.

After everyone had cleared out, my first order of business was the basket of referrals. I logged each one in, careful to ensure they'd be evaluated within the seventy-two-hour mandatory timeframe. Toward the bottom, one referral puzzled me. A Bing inmate named Rafael Ramirez was complaining of numbness and tingling, which struck me as a medical issue. I pulled his chart and was surprised to see that he'd recently been evaluated by Mental Health three times, with chart notes indicating nothing more than irritability and anxiety. The attending psychiatrists must have considered even that to be mild because they'd prescribed no medication. I took it up with the chief physician, who was also baffled as
to why the referral was given to mental health, and he agreed that medical should check him out.

The following day, Dr. Sackett informed me that the medical team's efforts had been thwarted because Ramirez was in court. On Wednesday morning, he'd completed his Bing sentence and was transferred out of OBCC.

By Thursday morning, I'd forgotten all about Ramirez when I got a disturbing call from Janet. “Mary, did you hear the news? There was a suicide, a hanging at AMKC, general population.” I sat up straight. While suicide attempts were an everyday occurrence on Rikers, completed suicides were infrequent and, for the Mental Health Department, particularly upsetting. Although our interventions kept suicides down to a handful a year, we could not prevent them all.

“And I hate to tell you this,” she added, “but he was just transferred from the Bing.”

“The Bing! What was his name?”

“Rafael Ramirez.”

Rafael Ramirez!
How in the world did numbness and tingling translate to suicide? I got off the phone with Janet and started pacing the room. This was terrible. What happened when he'd gone to court? Maybe he'd been given a stiff sentence. I just didn't know.

Even though I'd never met Ramirez and he'd killed himself in another jail, this was the closest I'd come to a suicide. When I'd been a clinician, I was fortunate that, of the hundreds of depressed inmates I'd worked with, none had killed themselves. But when it had happened to others, Montefiore Hospital, our former employer, was always supportive, bringing staff together, allowing us to talk and grieve. But it was a new day, and the phone had yet to ring with a call from St. Barnabas.

As the day wore on, I learned through the grapevine that his chart had been found in proper order, with all protocol followed. This brought a certain relief, but of course it would not bring the dead young man back. I kept reviewing the sequence of events, wondering if there might have been a different outcome if I hadn't
referred him back to medical. But even if I'd scheduled him for another evaluation, his appointment wouldn't have been until the tail end of the seventy-two hours, at which point he would already have been gone from OBCC. It would have made no difference. Still, I felt I needed to talk this out with my superiors, so I stayed close to the phone. But by Friday afternoon, when there was still no call from Central Office, I realized that the support we'd been afforded by Montefiore was a thing of the past. Instead, I simply said a quiet prayer for the soul of Rafael Ramirez.

The following Monday Kelly returned, to my great relief. The suicide had unnerved me, and I didn't want to run things alone anymore. But it wasn't to be. Just as George had sat me down when I started at the Mental Health Center, Kelly did the same. No, she wasn't quitting, but she was taking time off for a surgical procedure. Recovery would be anywhere from two to eight weeks.

Kelly's announcement hit hard and, in hindsight, was my strongest cue to get out. But I didn't see it. What I saw was that we had a great staff, a manageable building, and with it the potential for high-quality work. If this was the final hurdle before things settled down, I could do it—especially if Kelly was only gone for two weeks, although in my heart I knew that was unlikely. Kelly had already had several run-ins with St. Barnabas and wouldn't be rushing back anytime soon. Realistically, I was looking at the full eight weeks—if she returned at all. In a phone conversation with Hugh Kemper, he tried to be encouraging. “Kelly'll be back before you know it. And don't forget, I'm interviewing for a clinical supervisor, so that spot could be filled before she even returns. Let's think positive, Mary!”

I wanted to believe him, but when we hung up, I knew I was in for a long, hot summer.

33

On Monday, June 14, 1999, I took over as acting chief of Mental Health at the Otis Bantum Correctional Center. Despite my nervousness, I was buoyed by the staff; they rallied around me and even pitched in with some of my administrative tasks.

In some ways, things got off to a promising start. I was especially pleased with developments on the MO, where Theresa tackled the problem of the dorm's unused interview rooms. Since cleaning them out required DOC's assistance, and because DOC dragged its heels with anything beyond its own security concerns, I wasn't overly optimistic. But when Theresa approached the MO captain, he responded favorably. Captain Catalano, an eager young man, agreed to have the junk removed and the rooms painted. Although Theresa explained that a cheerful environment would be beneficial to the patients, I think he was far more interested in Theresa than the mentally ill. Regardless, he fulfilled his promise, and we now had two usable rooms for individual sessions. Building on this, with Catalano's permission, Theresa and Kathy brought in plants and old paperbacks for the patients to read.

We kept the momentum going by devising a weekly schedule of group therapy that included the topics of community living, violence reduction, and substance abuse. During my daily rounds, I was delighted to see that our Mental Observation Unit was developing into a true therapeutic environment and that our patients
were no longer lolling around on their cots and watching TV but were now participating in mandatory group sessions.

When it came to general population, my biggest challenge was ensuring that referred inmates were evaluated in a timely manner. The last thing I wanted was for someone to fall through the cracks, especially after the Ramirez suicide. The GP sessions took place in the clinic, where it irritated me that our quarters were crowded and cramped, especially since the medical staff was allotted roomy space. Our doctors and therapists were doubled up in booths that served as makeshift offices, so when an inmate arrived for his session, one person had to vacate the booth to maintain privacy. It rankled me that the treatment of intangible maladies such as depression—easily as agonizing and devastating as the worst physical pain—were always given such short shrift. But considering everything else I was faced with, now was not the time to challenge the existing arrangement.

It was the Bing, however, where I wasn't feeling so confident. Almost every morning, I received a call from the punitive unit informing me that someone was threatening to kill himself. Thankfully, Pete and Dr. Diaz were accustomed to these situations, and I would dispatch them to investigate. Diaz would adjust the meds, and he and Pete would talk to the inmate, trying to cajole him into enduring the punishment. But it wasn't long before Diaz called me from the Bing, asking that I come up to 4 South. This meant there was a tough decision to be made, and it was a nervous walk through the jail. When I reached the punitive unit, I stepped into an elevator car, and since I was going to the fourth floor, I held up four fingers to a corner camera, waiting to be spotted on a TV monitor. As the car lifted, the errant cries of the punished echoed throughout the cavernous tower, and I winced at the sound of a particularly piercing howl. When the door opened, a swarm of officers were hovering around a captain who was pressing a radio to his ear. From what I could glean, an inmate on the floor above had set fire to his mattress. The captain and COs disappeared into a stairwell and pounded upstairs to extinguish the fire. The inmate
would be “extracted” from his cell and “arrested” for arson. Despite the heat, despite the additional legal charge—despite, even, the possibility of death—I was already learning that setting fires is a common ploy to gain relief from the torment of solitary. But I had also noticed one aspect of fire-setting that was never discussed: Who supplied the matches?

My arrival at 4 South was a far cry from my first quiet visit. The noise level was ferocious; the inmates were wide awake, railing violently against their confinement. Bodies thumped against the doors and faces were pressed into the small windows. As I walked past the cells, they cried out to me,
“Miss! Help! Please, miss!! Please!”
Fighting my natural urge to rush to their aid, I reminded myself that they'd done something to warrant this punishment—hurt another inmate, perhaps, maybe cut someone.

I kept my eyes trained on Diaz and Pete, who were standing in front of a cell with its door slightly ajar.

“Welcome,” Pete said wryly.

Diaz motioned me to the side of the cell. “His name's Leonard Putansk. He's been going downhill for a while. We've done the usual, upped his meds, talked to him, but we've got to make a decision here. I don't think he's ready to come out yet, but we're getting close—there's a lot of blood. I think you need to take a look and then we'll decide. You ready?”

I steeled myself and nodded.

The officer pulled the door open to reveal a claustrophobic cell, the cement walls smeared with crimson stains. A burly young man in a sweat-soaked T-shirt sat on the cot and sobbed, his back to me. But he turned around quickly, his forearms slathered with blood.

“Please, miss! Please! Help me! My family, they're in Kosovo—I don't know if they're dead or alive with all the fighting going on over there!”

“I'm sorry about your family,” I said softly. “That must be very hard.”

“It is—it is! I've already been in this cell for three months now. They've got me down for another six. They wouldn't do this to a
dog! I'm going to kill myself. You gotta get me out of here! I can't take this anymore, I can't. I'm telling you, I can't.”

“Okay, just a minute now,” I managed, stepping back out.

Diaz motioned me out of Putansk's earshot. “It looks worse than it is,” he said. “He's picking at his skin. It's superficial. He's trying to make it as dramatic as he can so we'll pull him out.”

“He's doing a pretty good job,” I said. “So, why don't we pull him out, send him over to MHAUII?”

“It's not that simple,” said Pete. “He's desperate, but they all are. We can't pull them out just because they're miserable; that's the whole idea. We only intervene if we think his life is at stake, and at this point, I don't think it is, although he's going to up the ante.”

“Well, if we know he's going to do something more drastic, why wait?”

“Because we can't give in,” Diaz replied. “If we do, they'll all start cutting themselves and threatening suicide. It's a tug of war, Mary. Welcome to the Bing.”

As his words resonated, a sick, weak feeling washed over me. But I had to push it aside and stay focused. “But he's already been in there for three months! With
six
more to go!”

“That's nothing,” said Pete. “In these supermaxes they're building all over the country, they throw people in a cell for the rest of their lives.
‘Here's your life—a square box.
'”

I shuddered at the thought. A human life—relegated to a box.

Since Diaz and Pete were disinclined to pull him out, I deferred to their experience and the three of us went back into the cell and informed Putansk of our decision. In response, he howled and beat the walls with his fists. “We'll get someone from medical to take care of those cuts,” said Pete. Diaz nodded to the CO, who shut the door and locked it up. As we made our way out, Leonard Putansk's agonized wails seemed to follow us.

As the day wore on, I tried to focus on other matters, but I kept thinking about Putansk. I just hoped he was doing a little better. When we didn't hear anything more from the Bing, I relaxed a
little. But the following afternoon, the call came: “They're cutting someone down, a Leonard Putansk.”

My stomach knotted at the words—
cutting someone down.

I pushed my paperwork aside and put my head in my hands. I was not cut out for this. The phone rang again, and this time it was Dr. Campbell, the new director of Mental Health. Somehow, the news had already reached him at Central Office. “Find out if he's dead or alive and call me back,” Campbell snapped.

I forced myself out into the clinic where a swarm of officers, keys jangling at their sides, were running the gurney down the main aisle. In the examining room, Putansk was quickly surrounded by a sea of white lab coats. In the thick of things was Diaz, who waved me in from the doorway. As I reluctantly approached the table, Diaz put his big arm around my shoulders and ushered me up to the semiconscious inmate, pointing to the thick pink welt where the sheet had dug into his neck.

“He's okay,” Diaz smiled. “Don't worry, he's going to be fine. I knew he was going to do something, but he timed it for when a CO would be walking by. We'll send him to the hospital and when he comes back, he'll go to MHAUII.”

“He's going to be okay,” Diaz reiterated, in response to what must have been my ashen face. For him this was everyday stuff, but for me it was all new—and all horrifying. As Leonard Putansk was stabilized with a neck brace and wheeled out to a waiting ambulance, I wondered how I could ever come to terms with any of this.

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