10
Riley
Daniel Westbrook
Building, Third Floor
1330 Lady Street
Post Office Box 11070(29211)
Columbia South Carolina 29201

LLP

Re: South Carolina Department of Corrections
Lieber Correctional Institution
Alternative Crisis Intervention Housing Placements
Dear Mr. Westbrook:
During the morning of November 8, 2010 we received a tour of the alternative housing cells used
for crisis intervention purposes at Lieber CI, although it was initially an incomplete tour related
to the staff apparently not knowing where all such placements occurred.
The SMU is located in L building. We were shown two large holding cells with toilets that were
used for crisis intervention (C[) purposes. The toilet in one of the holding cells had a wall which
prevented adequate observation. Windows had bars and there was a large hole in the ceiling. It
was possible to climb up the windows due to the bars and probably have access to pipes hanging
down from the ceiling. There was also exposed (uncovered) tluorescent lighting at the top of the
cells. These large holding cells were not suicide resistant.
Two smaller holding cells, without a toilet, were reported by several inmates as having been used
for
These cells were nowhere close to being suicide resistant and
had
the
Reference should
made to the photographs taken
tour

Correctional Institution

holding areas and fully
itself
areas were not
suicide resistant.
We also inspected the shower area used tor crisis intervention purposes which was very small,
dark, and the visibility was very poor tor observation purposes. The inside of the shower was not
visible to anyone unless the person \vas immediately tacing the cell door entrance to the shower.
We were told by Mr.
that only one shower on the upper tier on A side was used for
such purposes. This shower did not have mesh wiring on the door. During the course of our
interviews with inmates, we were told by some that they had been housed in the "A" side lower
tier shower. We inspected the lower tier shower and it was as with the upper tier shower not
visible as a line of site unless the observer was standing at the door of the shower itself The
shower on the lower tier on "A" side had a wire mesh door in contrast to the sho\ver on the upper
tier.
Staff had not been aware that the interview rooms were being used for crisis intervention. There
was a hole in the wall and lighting was poor.

Current SMU inmates
1. Inmate 1

Inmate 1 was a 27-year-old man who had been in the SMU for about two years. He reported
having had alternative crisis cell placements that included housing in the recreational
holding cell,
room and
was placed in the shower on B side (both upper
and
in duration
seven hours (e.g., 4 PM-II PM) to

PLT.I081

Intervention

Inmate 1 described
embarrassed by lack of clothing, especially when he \vas placed
that exposed him to significant inmate tramc.

the

When placed in the recreational
inmates from that particular housing unit would
to the
other side for recreational purposes. However, they would pass the recreational cage and often
to the inmate placed in it
The CRT of this inmate was reviewed. A February 21,2009 note by Lolita Lee, CCC indicated
that Inmate 1 was in the recreational cage without clothing but with a suicide blanket
CRT documentation during August 20, 2008 indicated that this inmate \vas placed in the MA
wing cage for crisis intervention purposes. He was wrapped in a suicide blanket Melvin
Ransom, HSC II wrote during August 21, 2008 that this inmate was removed trom crisis
intervention.
During March 2010 Inmate I was placed in a holding cell for CI purposes.
Inmate 1 was wearing a pink jumpsuit

2. Inmate 2

This 26-year-old African-American male reported that his alternative crisis intervention housing
placements have included being in the recreational cages on both sides of the SMU, in the
shower on one occasion for 30-60 minutes, in the interview booth and in a holding celL His
a holding cell
Christmas 2008 was documented in the CRT.

PLT.I082

Placements
40f17

The CRT was

was placed a
cell during 411
a suicide blanket "if available."

for CI

Inmate

Inmate 2 was in a pink jumpsuit.

3. Inmate 3
This inmate was in the interview booth for 16 hours from June 20-21, 2010. The logbooks
demonstrated placement in the interview booth and records in the CRT described holding cell
placement. A June
2010 psychiatrist's evaluation note indicated that the differential
diagnosis was psychosis NOS versus major depressive disorder with psychotic features.
Wellbutrin and Risperdal were prescribed.
Inmate 3 was a 28-year-old man, who reported that he was placed in the interview room for crisis
intervention purposes between June-August 2010 fur almost 24 hours. He described infrequent
checks by custody staff because the placement occurred during the weekend (e.g., up two hours
at a time without seeing a correctional officer). Inmate 3 indicated that he had to urinate on the
Hoor and had to clean it up with paper towels provided to him for purposes of sitting on the stool.
He was naked throughout the experience without any coverings. He would be escorted down the
hallway tor defecation purposes, which he described as being a very humiliating experience
related to the lack of clothing.
The interview room did not have a light and the hole in the ceiling exposed various pipes and
ducts. He was interviewed by Mr. Ransom. Inmate 3 was not receiving medications at that time
although
was later prescribed Risperdal and Wellbutrin. The Risperdal was later changed to
Haldol.
were described as
been helpful.

4. Inmate"

holding
occurred about
He was interviewed by mental
and was eventually sent back to
Inmate 4 told
mental health
clinician that he wanted to
sent back to the cell due to the conditions of confinement in
the
U,,"H.'-4U";:;'

next placement in a
cell alternative occurred around September 15,2010 when he was
placed in a recreational
for about
hours under similar conditions. The CRT indicated
placement in a holding cell at that time. Inmate 4 reported that again he would urinate on the
floor due to lack of access to a toilet. The correctional officers in the booth could observe an
inmate in the recreational cage.
Food was offered but he did not want to eat the food because he did not have utensils and his
hands were very dirty related to the conditions of confinement. He was interviewed by Ms. Lee
at the ceUfront-he was naked. He had been transferred to a crisis intervention cell prior to this
interview.
was described as "'H"vau
Inmate 5

and humiliating.

access to

this

A July
,u,"",-... ,-.u that he was
in
was noted to
July
a suicide blanket wrapped around
person. He was
removed from suicide status during July 1 2010 by
HSC II.
Documentation was not present relevant to his placement in the interview booth as summarized
above.
This inmate was not receiving psychotropic medications.
6. Inmate 6
Inmate 6 is a 46 old African-American man who stated that he was placed in a holding cell for
crisis intervention purposes for about 4 to 5 days during the end of July 2010. He reported that
he was not seen by mental health staff during this period of time. He also stated that he was
naked without any kind of covering. He periodically would have to urinate on the t100r or on his
food tray due to poor access to the bathroom. He reported that the correctional officers
infrequently checked on him. He eventually was transferred to OPB.
This inmate had been prescribed Oeodon and Prozac. He reported that he has been diagnosed as
having paranoid schizophrenia.
The CRT of this inmate was reviewed. He was placed on crisis intervention during July 29,
2010 after cutting his abdomen and left wTist. He was evaluated by mental health staff based on
the CRT documentation although he denied such assessments. Fifteen minutes observation was
reported to occur
the staff based on the CRT. £t appeared that he was admitted to OPH by
10.

\vas no
don't

,""un.-nom

are
however he was »butt naked"

nt'I""""n1

they would let him out so
occurred.

he

to the

The inmate stated that his
saw him on the second day that he was placed in the booth
and took him otIthe CI status; he stated he had not seen any mental health staff on the first day.
The inmate stated that food was delivered on a Styrofoam plate and that he had to eat within the
interview booth.
The inmate stated this was a very humiliating experience tor him of being housed in an interview
booth where inmate and staff traffic passed during the day and evening shifts and he was placed
naked in the booth. He also reported having to bang on the door to request the use of a bathroom
which was very embarrassing for him, and eat tinger foods without washing his hands.
The inmate reported he did not tile any grievances on these events. He also reported that when
he was released from CI status he was returned to his regular SMU cell.

8. Inmate 8
Inmate 8 was a 21-year-old male \vho reported he had been incarcerated at SCDC in the Lieber
SMU for the past two years. The inmate stated he was prescribed loloft and Remeron for that
entire time. He stated he sees his counselor approximately one time per month and sometimes
more if he makes the request although it takes approximately two days for a response to his
request.
The inmate reported
booth and

never been in the CI camera cells but he
been in the interview
. \\!nen I
how many times he estimated he had
10

Placements

or
or the next
in most cases but in one case
had to wait seven
he was placed on a Wednesday
didn't see mental health
until
stated he was then taken off CI status and returned to
SMU cell.
lll,".1\.1.;1.1

."\."'-1,"'Ul.

The inmate reported that finger fDods are delivered on a Styrofoam tray but that there is no
facility for an inmate to wash his hands or engage in any hygienic activities when placed in these
alternative areas.
The inmate stated that he received no rec time when placed in these alternative placements and
that sometimes the other inmates either don't get to go out for rec or they must go out on the
other side C'A" or "B"). The inmate stated he put in a grievance when he \vas in the rec cage for
seven days that he sent to Columbia but "nothing happened".

9. Inmate 9
Inmate Number 9 is a 39-year-old male who reported he had been incarcerated tDr the past 10
years and in the SMU at Lieber fDr nearly two years.
The inmate reported that he had been placed in a CI cell when he tirst came to Lieber and
remained there for three days. He reported since that time he was placed in a rec cage
approximately six or seven months ago tDr three days and the records reviewed indicate he was
in a rec cage for 62 hours in April 2009.
When I asked specifically where in the rec cage he reported between the two wire mesh doors.
He stated he was
little bottle to pee or I would have to wait sometime after banging on
the door."
while in the rec
he was "butt naked" with no blanket

10. Inmate 10

at

11
states
been
at Lieber the counselors

past 11

and that

see him at the

is supposed to come and see inmates whenever they
The inmate stated his belief that Dr.
charges and make reports to the DHO but added "he never does" come to see them. The
inmate stated that the counselors also do not make their 30 day rounds and that he last saw Dr.
approximately two weeks ago when he was on CI status.
The inmate reported on 10/25 he was having suicidal thoughts after learning of the death of his
little brother and he informed Dr.
The inmate stated Dr.
said that he \vould
return to talk with him however a lieutenant carne and told the inmate that Dr.
was not
going to place him on CI status. The inmate stated that later that day he took a handful of pills in
front of the nurse
which included his Zolotl, Remeron, and Risperdal, some of which
were prescribed for him and some which he got from other inmates.
The inmate reported he was then placed in the CI cell but he has also been placed in the holding
cell and the rec cage and each time he was "butt naked".
This inmate stated that he observed a sergeant placing two inmates including inmate number 11
(see below) and another inmate in a holding cell together and both were "butt naked".
The inmate stated the last time that he was in a holding cell was in August and that he has
refused to go to the showers when oftlcers have told him he was going to be placed on CI status
in the showers.
or rec

The inmate
has tiled at least three
based on these experiences as well as
his
been placed in the interview booth tor four to five days in July or August 2010,
'-betore Ramadan. ,The inmate estimated that he has been placed in either the interview booth, holding cell or rec
cage between 10 and 15 times but that he has never been placed in the shmver. The inmate
reported these experiences have been very humiliating and embarrassing for him and that he "vas
particularly frightened and paranoid when having been placed in a holding cell naked with
another inmate and no outside observation by correctional statT.
12. Inmate 12
Inmate Number 12 is a 33-year-old male who reported he has been incarcerated for the last 15
years and in the Lieber SMU since February 2008.
The inmate reported that he has been receiving mental health treatment for a number of years
including prescriptions of Zoloft and Risperdal for depression and as an "anti-stimulant".
The inmate reported he has been placed in CI cells in other facilities but not at Lieber. He stated
that in 2009 he reported suicidal ideation, and was placed in the shower all night. The records
indicate that he was placed in the shower for 15 hours in June 2009. During that placement the
inmate stated the correctional statT took him to the CI cell to use the bathroom and then returned
him to the shower. He reported he was in the shower tor 24 hours and that no mental health staff
saw him during that time. He stated that when he was released from the shmver he was placed
SMU cell that was stripped out. The inmate stated that later that day,
back in his
and took him otT status.

PLT.

a number

13. Inmate 13

Inmate Number 13 was a 30-year-old male who has been in the SCDC since 2004. He reported
he has been at Lieber in the SMU for the past two
The inmate reported he has been
"for paranoia, emotions, seeing things, hearing things." The
receiving mental health
inmate reported he has been placed in the CI cells on three occasions because he was suicidal
which included his having cut himself as well as swallowing glass. He reported that he was in
the cells four to five days on two occasions and for one week on the third occasion. He stated
that the counselors did not come to see him until after two days on each of these occasions and
they only asked if he still felt like killing himself. The inmate stated that when he said no he was
taken back to
room.
The inmate reported that he had been in a holding cell on two occasions with the last being
approximately two months ago when he was in a holding cell tor three days. He stated one of
the holding cells was a small holding cell where there was no toilet or sink and that when he was
taken from that holding cell he was placed in the interview booth for one day. The inmate also
reported that he has been in the shower downstairs for 10 hours and then moved to a holding cell.
While in the shower the inmate reported that he was brought tood on a Styrofoam plate and told
ifhe did not eat the food in the shower he would forfeit his food.
While in the holding cell the inmate reported that he banged on the door but no CO responded
and he was forced to use his food tray to urinate on because he couldn't hold it. He stated he was
"butt naked" when placed in the holding cell and had no gown or blanket. He stated that when
mental health staff came to see him they took him off CI status and he was returned to his
SMU celL

14. Inmate 14
at

1.

Intervention

Placements

he
never
placed in the CI cell but
has
placed in the
twice in the
of months because of having suicidal
and in the rec
panic attacks.
The inmate stated on one occasion he was placed in the shower trom 8 pm until 5-6 pm the
following day and was "butt naked" and had no blanket. He stated that he was given linger food
in the shower and that a mental health counselor came to see him and when he told her he was
tine she took him off CI and he was returned to his SMU ceiL
The inmate stated that he had been placed in the rec cage for 36 hours because he was suicidal
and again was butt naked and given linger foods to eat from a tray. He stated there is no toilet in
the rec cage and he would have to wait for an officer for one to two hours tor toileting. He stated
he was unable to wait and had to urinate in a comer on one of these occasions.
He stated he was placed in the rec cage on another occasion for 24 hours because he was suicidal
and encountered the same conditions.
The inmate stated that he was placed in a shower on a fourth occasion from 2-3 pm until 5-6 pm,
less than a full day in July he believes.
The inmate stated he tiled three grievances in the last couple of months but he has received no
responses.
The inmate reports that he asked Dr.
about medication and that he was prescribed Zoloft
the psychiatrist but he never actually saw the psychiatrist to discuss the medication.

PLT.

placed in
over 10
He

The
having been placed in these alternative placements with no clothing and
required to eat
foods, without toilets or sinks that would allow for him to use a proper
bathroom or wash his hands or
in any other hygienic activities.
The inmate said he has filed 37 separate grievances which have been about health care and
mental health care. He stated his belief that statT need training because they are punishing
inmates who have mental health problems. The inmate asked whether or not I had seen the
SCDC Newsletter in 2000-2001 which reported awards being given to District Managers tor
decreasing the number of inmate grievances.
This inmate reported having been placed in alternative placements and that this was humiliating
tor him as well as punishment to him and other inmates.
16. Inmate 16

Inmate Number 16 is a 25-year-old male vvho has been incarcerated at SCDC for the past eight
years. He stated he has been in Lieber for the past seven years and in the SMU tor the last six
years.
The inmate stated that he has been receiving mental health services since he was a child and has
had diagnoses of bipolar disorder and borderline personality disorder. He has been treated with
Neurontin, Seroquel, Risperdal and Geodon and is currently prescribed Neurontin.
The inmate reported he sees his counselor "every blue moon" but has seen Dr.
three

two to

Lieber Correctional Institution
Intervention

The inmate stated that \vhen he has been taken otf of CI status by the counselor he has been sent
back to his SMU cell and "nothing changes."
The inmate stated that he has wTitten to his Senator who wrote to
who wrote to the
Senator saying that he, the inmate, had too many charges. The inmate offered that he does have
a problem with masturbation and he keeps asking for treatment but "nothing happens". He
continued "I need help and they don't give it."
The inmate reported he has filed two grievances but he has received no reply.
This inmate emphasized several times during the interview that he believes mental health staff
are not providing treatment and even when he has been placed on crisis intervention status in
alternative placements, when that status has been discontinued there has been no change in his
treatment and no discussions regarding his having suicidal or other behaviors requiring crisis
intervention services.

Summary

Although there were some credibility issues based on discrepancies bet\veen infonnation
obtained from some of the inmates and review of their CRT records, there were significant
consistencies in histories obtained from these inmates who reported no or little knowledge
regarding the purpose of these interviews. Information that appeared to be reliable included the

PLT.

5. Inmates unifonnly described
no clothes and most of them reported
no
other
suicide blanket). Many indicated that they \vere told by
correctional officers that there was only one suicide blanket available. When some of
them eventually got the blanket they complained that it had not been cleaned.
6. Many of these inmates did not have access to toileting facilities or sinks to wash their
hands before or atter eating. They described having to urinate on the noor in one of
the holding cells or in the shower and one of them described having to defecate in the
holding cell.
7. These inmates unifonnly described these alternative CI housing placements as being
embarrassing and humiliating.
The use of these cells for CI purposes, as well as the associated procedures employed, is clearly
below the standard of care for many reasons. These reasons included the following:
1. They were dangerous from a safety perspective in the context of not being suicide
resistant. In addition, the lack of appropriate observation by staff and apparent
periodic lack of mental health assessments contributed to this lack of safety.
2. The conditions of confinement were dehumanizing and likely to exacerbate mental
health problems that led to the inmate's placement on CI status. Such conditions
included no clothing, generally no coverings, and inadequate access to toilets in many
of the "alternative placements."
3.

5.

Lieber Correctional Institution
Re: Alternative Crisis Intervention Housing Placements
Page 160f17
and the inmate~ was reported by these inmates to not occur nor was it demonstrated
by review of the records. This practice of lack of multidisciplinary comprehensive
treatment planning has been consistent across facilities in the scne.

Jeffrey Metzner, M.D.

Raymond F. Patterson, M.D.